Factors associated with the recommendation for endocarditis prophylaxis in mitral value prolapse
C. J. Lavie, B. K. Khandheria, J. B. Seward, A. J. Tajik, C. L. Taylor and D. J. Ballard
Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905.
We conducted a population-based study to examine the association between
clinical and Doppler echocardiographic characteristics and physicians'
recommendation for endocarditis prophylaxis. Of 127 consecutive Olmsted
County, Minnesota, residents with newly documented isolated mitral valve
prolapse, endocarditis prophylaxis was recommended three to four times more
often in patients under 40 years compared with those more than 60 years of
age. Using multiple logistic regression, for every 10-year increment in
age, there was a 30% independent reduction in recommendations for
endocarditis prophylaxis. Doppler evidence of mitral regurgitation was also
independently associated with recommendations for endocarditis prophylaxis.
Observations from physical examination, including systolic murmur and
systolic click, were weakly associated with endocarditis prophylaxis
recommendations. Mitral valve appearance (thickened vs not) was not
associated with endocarditis prophylaxis. Although current recommendations
for endocarditis prophylaxis and mitral valve prolapse do not address age
and Doppler-detected mitral regurgitation, these variables are strongly
associated with clinical decisions. Prospective, longitudinal,
population-based studies are needed to define endocarditis risk further in
subgroups with mitral valve prolapse to provide a more scientific basis for
clinical decision making.
