Non-bacterial Thrombotic Endocarditis

Abstract

Non-bacterial thrombotic endocarditis or also called verrucous endocarditis or Libman-Sacks endocarditis or marantic endocarditis is a rare entity, still unknown physiopathology, which is characterized by the formation of sterile vegetations at the valvular structures. These vegetations of platelet aggregates and fibrin are sterile by definition, so for its definitive diagnosis, it is essential to rule out an infectious endocarditis. It is mainly diagnosed by echocardiography in patients with neoplasms or systemic autoimmune diseases. Its main complication is the formation of multisystemic embolisms, preferably at the brain level, so anticoagulation will be fundamental in the treatment and evolution of non-bacterial thrombotic endocarditis.

Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021

“…• Пациентам с НБТЭ для дифференциальной диагностики с ИЭ рекомендовано выполнять специальные лабораторные исследования оценки клеточного состава крови и системы гемостаза [320,321].…”

Nonbacterial thrombotic endocarditis with atypical presentation as overt congestive heart failure

“…This condition, also known as marantic or verrucous or Libman–Sacks endocarditis,[ 1 ] is often associated with malignancy, systemic lupus erythematosus (SLE), or antiphospholipid antibody syndrome, and in most cases, it involves left side valves. [ 1 2 3 4 5 6 ] NBTE is a rare disease mostly found postmortem with a reported prevalence of about 1%–1.5% at autopsy,[ 6 7 ] but recently reported up to 3.7%. [ 8 ]…”

“…Then, occurs deposition of platelet thrombi, immune complexes, inflammatory cells, and fibrin in the affected tissue, ultimately resulting in vegetations that may dislodge and cause systemic embolisms. [ 2 3 5 6 ]…”

“…Diagnosis of NBTE remains a challenge as patients are often asymptomatic until their first embolic event or more rarely, the occurrence of significant valve dysfunction. [ 2 3 9 ] A high clinical suspicion is thus crucial for the diagnosis. A definitive diagnosis can be made only pathologically by autopsy or surgical specimens, as no laboratory tests can confirm NBTE.…”

“…Treatment of NBTE is not well-defined and targeted guidelines are lacking. [ 2 3 4 12 ] Indications for cardiac surgery (vegetation excision or valve replacement) are the same as for IE[ 13 ] and the underlining disease requires treatment as well. In the case of conservative treatment, echocardiography is an invaluable tool to monitor the progression or resolution of the disease during the follow-up.…”