Exploring the Complexities of Non-Bacterial Thrombotic Endocarditis: Highlights from Literature and Case Studies
Abstract
:1. Introduction
2. Epidemiology and Etiology
3. Pathophysiology
3.1. Immune Complexes
3.2. Hypercoagulable States
3.3. Carcinomatosis
4. Clinical Presentation
5. Personal Case Contribution
5.1. Case 1
5.2. Case 2
5.3. Case 3
5.4. Case Discussion
- Previous deep venous thrombosis and weight loss could be considered as red flags for marantic NBTE (as in cases 1 and 3);
- The fundamental role of multimodality imaging (TTE + TEE, brain MRI, 18F-FDG/PET–CT scan) for NBTE diagnosis;
- The role of 2D and 3D-TEE for detection and characterization of NBTE valvular lesions;
- Failure of direct oral anticoagulants (DOACs) in NBTE setting (as in cases 1 and 3);
- The need for a tailored antithrombotic therapy;
- Efficacy of 100 mg aspirin in reducing NBTE lesions (case 2: Libman–Sacks endocarditis, high-risk APLs profile, and thrombocytopenia).
6. Diagnosis
6.1. Laboratory Investigations
6.2. Multimodality Imaging
7. Treatment
7.1. Specific Treatment for the Predisposing Condition
7.2. Antithrombotic Therapy
7.3. Surgery
8. Prognosis and Follow-Up
9. A Specialized “NBTE Team” Could Be Useful?
10. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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NBTE | INFECTIVE ENDOCARDITIS | |
---|---|---|
Predisposing conditions: | Cancer Autoimmune disorders Hypercoagulable states | Previous IE Valvular heart disease Prosthetic heart valve Congenital heart disease (CHD) Transvenous cardiac implantable electronic device Central venous or arterial catheter People who inject drugs (PWID) |
Clinical presentations: | ||
Fever | − | + |
Valve dysfunction | + | ++ |
Heart failure | + | +++ |
Embolic events | +++ | + |
Microbiology: | Negative serial blood cultures/serology/PCR | Blood cultures/serology + in up to 70% of cases |
Echocardiography: | Valvular thickening Verrucous, broad based, irregular vegetations, especially at valvular leaflets tip Possible false negative results if already embolized + Left-sided heart valves | Mass of variable echo density, mobility and location +++ Paravalvular complications Right-sided predilection in PWID |
CT scan: | Cardiac CT
Whole-body CT
| Cardiac CT
Whole-body CT
|
Brain MRI: | Usually, small disseminated infarcts | Typically, a large infarct confined to a single vascular territory |
PET/CT scan: | [18F] FDG uptake – for cardiac lesion | [18F] FDG uptake + for cardiac lesion |
Cardiac surgery: | + +++ Valve sparing | ++ ++ Valve replacement |
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Santarpino, G.; Lofrumento, F.; Zito, C.; Trio, O.; Restelli, D.; Cusmà Piccione, M.; Manganaro, R.; Carerj, S.; Cardetta, F.; Fiore, C.; et al. Exploring the Complexities of Non-Bacterial Thrombotic Endocarditis: Highlights from Literature and Case Studies. J. Clin. Med. 2024, 13, 4904. https://doi.org/10.3390/jcm13164904
Santarpino G, Lofrumento F, Zito C, Trio O, Restelli D, Cusmà Piccione M, Manganaro R, Carerj S, Cardetta F, Fiore C, et al. Exploring the Complexities of Non-Bacterial Thrombotic Endocarditis: Highlights from Literature and Case Studies. Journal of Clinical Medicine. 2024; 13(16):4904. https://doi.org/10.3390/jcm13164904
Chicago/Turabian StyleSantarpino, Giuseppe, Francesca Lofrumento, Concetta Zito, Olimpia Trio, Davide Restelli, Maurizio Cusmà Piccione, Roberta Manganaro, Scipione Carerj, Francesco Cardetta, Corrado Fiore, and et al. 2024. "Exploring the Complexities of Non-Bacterial Thrombotic Endocarditis: Highlights from Literature and Case Studies" Journal of Clinical Medicine 13, no. 16: 4904. https://doi.org/10.3390/jcm13164904