Nonbacterial thrombotic endocarditis
- Kenneth A Bauer, MD
Kenneth A Bauer, MD
- Professor of Medicine
- Harvard Medical School
Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that refers to a spectrum of noninfectious lesions of the heart valves that is most commonly seen in advanced malignancy. NBTE is often an autopsy finding. However, some patients are diagnosed antemortem presenting with the signs and/or symptoms of systemic embolization and require therapy.
The epidemiology, pathogenesis, clinical presentation, evaluation, diagnosis, and treatment of NBTE are presented in this topic. The clinical manifestations and treatment of infective and culture negative endocarditis are discussed separately. (See "Epidemiology, microbiology, and diagnosis of culture-negative endocarditis" and "Antimicrobial therapy of native valve endocarditis" and "Clinical manifestations and evaluation of adults with suspected native valve endocarditis".)
Nonbacterial thrombotic endocarditis (NBTE) is a rare condition most often found postmortem with rates in autopsy series ranging from 0.9 to 1.6 percent [1-6]. It has been reported in every age group, most commonly affecting patients between the fourth and eighth decades of life with no sex predilection [1,7-9]. Patients with advanced malignancy and those with systemic lupus erythematosus are the most common populations affected by NBTE.
One autopsy series reported that, compared to the general population, patients with underlying malignancy have a higher rate of NBTE (1.25 versus 0.2 percent) [2,3]. When compared to other malignancies, higher rates were reported in those with adenocarcinoma (eg, lung, colon, ovary, biliary and prostate) (2.7 versus 0.47 percent) with the highest rates observed in patients with mucin-secreting and pancreatic adenocarcinoma (10 percent) [3,7,10].
In patients with systemic lupus erythematosus, observational studies using transthoracic echocardiography have reported prevalence rates of 6 to 11 percent, with higher rates (43 percent) observed when the more sensitive transesophageal echocardiography was performed [11,12]. (See "Non-coronary cardiac manifestations of systemic lupus erythematosus in adults", section on 'Verrucous endocarditis (Libman-Sacks endocarditis)'.)
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