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Mural Endocarditis: The GAMES Registry Series and Review of the Literature

Andrea Gutiérrez-Villanueva et al. Infect Dis Ther. 2021 Dec.

Abstract

Introduction: Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis.

Methods: Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series.

Results: Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p < 0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p < 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p < 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p < 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non-MIE, p = 0.006). Mortality was similar. MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p < 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar.

Conclusion: MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs.

Keywords: Endocarditis; Mural; Non-valvular endocarditis.

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Figures

Fig. 1
Fig. 1
Simultaneous bi-plane imaging by transesophageal echo showing a large sessile heterogeneous mass (3.9 × 2.8 cm) attached to the lateral and inferior wall of the right atrium, with irregular contour. The tricuspid valve and inferior vena cava were not affected
Fig. 2
Fig. 2
Distribution by calendar year of the cases of mural endocarditis from the literature (blue) and those from the GAMES registry (orange)
Fig. 3
Fig. 3
Location of mural endocarditis. a: Septum. b: Vena cava. c: Tendinous chords. A GAMES, B literature
See this image and copyright information in PMC

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