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December 15, 1989, Vol 262, No. 23 >
ARTICLE | December 15, 1989

Factors Associated With the Recommendation for Endocarditis Prophylaxis in Mitral Valve Prolapse FREE

Carl J. Lavie, MD; Bijoy K. Khandheria, MD; James B. Seward, MD; A. Jamil Tajik, MD; Catherine L. Taylor; David J. Ballard, MD, MSPH
[+] Author Affiliations

Presented in part at the 70th Annual Scientific Session of the American College of Physicians, San Francisco, Calif, April 13-16, 1989.

Reprint requests to Cardiology Department, Mayo Clinic, Rochester, MN 55905 (Dr Khandheria).


JAMA. 1989;262(23):3308-3312. doi:10.1001/jama.1989.03430230093032
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Article
References

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, populationbased studies are needed to define endocarditis risk further in subgroups with mitral valve prolapse to provide a more scientific basis for clinical decision making.

(JAMA. 1989;262:3308-3312)

REFERENCES

1 +
Reid JV.  Mid-systolic clicks . S Afr Med J. 1961;; 35:353-355.
2 +
Barlow JB, Pocock WA, Marchand P, Denny M.  The significance of late systolic murmurs . Am Heart J. 1963;;66:443-452.
3 +
Oakley CM.  Mitral valve prolapse: harbinger of death or variant of normal? Br Med J. 1984;;288: 1853-1854.
4 +
Savage DD, Garrison RJ, Devereux RB, et al.  Mitral valve prolapse in the general population, I: epidemiological features: the Framingham study . Am Heart J. 1983;;106:571-576.
5 +
Procaccli PM, Savron SV, Schreiter SL, Bryson AL.  Prevalence of clinical mitral-valve prolapse in 1169 young women . N Engl J Med. 1976;;294:1086-1088.
6 +
Markiewicz W, Stoner J, London E, Hunt SA, Popp RL.  Mitral valve prolapse in one hundred presumably healthy young females . Circulation. 1976;;53:464-473.
7 +
Darsee JR, Mikolich JR, Nicoloff NB, Lesser LE.  Prevalence of mitral valve prolapse in presumably healthy young men . Circulation. 1979;;59:619-622.
8 +
Levy D, Savage D.  Prevalence and clinical features of mitral valve prolapse . Am Heart J. 1987;; 113:1281-1290.
9 +
Retchin SM, Fletcher RH, Waugh RA.  Endocarditis and mitral valve prolapse: what is the 'risk'? Int J Cardiol. 1984;;5:653-659.
10 +
MacMahon SW, Roberts JK, Kramer-Fox R, Zucker DM, Roberts RB, Devereux RB.  Mitral valve prolapse and infective endocarditis . Am Heart J. 1987;;113:1291-1298.
11 +
Mills P, Rose J, Hollingsworth J, Amara I, Craige E.  Long-term prognosis of mitral valve prolapse . N Engl J Med. 1977;;297:13-18.
12 +
LeBauer EJ, Perloff JK, Keliher TF.  The isolated systolic click with bacterial endocarditis . Am Heart J. 1967;;73:534-537.
13 +
Clemens JD, Horwitz RI, Jaffe CC, Feinstein AR, Stanton BF.  A controlled evaluation of the risk of bacterial endocarditis in persons with mitralvalve prolapse . N Engl J Med. 1982;;307:776-781.
14 +
Hickey AJ, MacMahon SW, Wilcken DEL.  Mitral valve prolapse and bacterial endocarditis: when is antibiotic prophylaxis necessary? Am Heart J. 1985;;109:431-435.
15 +
Devereux RB, Hawkins I, Kramer-Fox R, et al.  Complications of mitral valve prolapse: disproportionate occurrence in men and older patients . Am J Med. 1986;;81:751-758.
16 +
MacMahon SW, Hickey AJ, Wilcken DEL, Wittes JT, Feneley MP, Hickie JB.  Risk of infective endocarditis in mitral valve prolapse with and without precordial systolic murmurs . Am J Cardiol. 1987;;59:105-108.
17 +
Danchin N, Voiriot P, Briancon S, et al.  Mitral valve prolapse as a risk factor for infective endocarditis . Lancet. 1989;;1:743-745.
18 +
Nishimura RA, McGoon MD, Shub C, Miller FA Jr, Ilstrup DM, Tajik AJ.  Echocardiographically documented mitral-valve prolapse: long-term follow-up of 237 patients . N Engl J Med. 1985;; 313:1305-1309.
19 +
Marks AR, Choong CY, Sanfilippo AJ, Ferré M, Weyman AE.  Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse . N Engl J Med. 1989;;320:1031-1036.
20 +
Shulman ST, Amren DP, Bisno AL, et al.  Prevention of bacterial endocarditis: a statement for health professionals by the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Disease in the Young . Circulation. 1984;;70:1123-1127.
21 +
Ballard DJ, Khandheria BK, Tajik AJ, Seward JB, Weber V, Melton LJ.  A population-based study of echocardiography: time trends in utilization and diagnostic profile of an evolving technology, 1975-1987 . Int J Technol Assess Health Care . 1989;; 5:249-261.
22 +
Kurland LT, Molgaard CA.  The patient record in epidemiology . Sci Am. 1981;;245:54-63.
23 +
Come PC, Riley MF, Carl LV, Nakao S.  Pulsed Doppler echocardiographic evaluation of valvular regurgitation in patients with mitral valve prolapse: comparison with normal subjects . J Am Coll Cardiol. 1986;;8:1355-1364.
24 +
Panidis IP, McAllister M, Ross J, Mintz GS.  Prevalence and severity of mitral regurgitation in mitral valve prolapse syndrome: a Doppler echocardiographic study of 80 patients . J Am Coll Cardiol. 1986;;7:975-981.
25 +
Helmcke F, Nanda NC, Hsiung MC, et al.  Color Doppler assessment of mitral regurgitation with orthogonal planes . Circulation. 1987;;75:175-183.
26 +
Klein AL, Burstow DJ, Tajik AJ, et al.  Agerelated prevalence of valvular regurgitation in normal subjects—a comprehensive color flow examination of 118 volunteers . J Am Soc Echo. 1989;. In press.
27 +
Harrell FE Jr. The LOGIST Procedure: SUGI Supplemental Library User's Guide, Version 5 Edition. Cary, NC: SAS Institute Inc; 1986:269-293.
28 +
Devereux RB, Kramer-Fox R, Kligfield P.  Mitral valve prolapse: causes, clinical manifestations, and management . Ann Intern Med. 1989;;111:305-317.
29 +
Ballard DJ, Lavie CJ, Taylor CL, Khandheria BK.  Impact of Doppler echocardiography detected mitral regurgitation on endocarditis prophylaxis recommendations: a population-based study . Circulation . 1988;;78( (suppl II) ):II-585. Abstract.
30 +
Steckelberg JM, Melton LJ, Ilstrup DM, Wilson WR.  Influence of referral bias on the apparent clinical spectrum of infective endocarditis . In: Proceedings of the 29th Inter-Science Conference on Antimicrobial Agents and Chemotherapy; September 18, 1989, Houston, Tex .
31 +
Watanakunakorn C.  Changing epidemiology and newer aspects of infective endocarditis . Adv Intern Med. 1976;;22:21-47.
32 +
Terpenning MS, Buggy BP, Kauffman CA.  Infective endocarditis: clinical features in young and elderly patients . Am J Med. 1987;;83:626-634.
33 +
Greenfield S, Blanco DM, Elashoff RM, Ganz PA.  Patterns of care related to age of breast cancer patients . JAMA. 1987;;257:2766-2770.
34 +
Hayward RA, Shapiro MF, Freeman HE, Corey CR.  Who gets screened for cervical and breast cancer? results from a new national survey . Arch Intern Med. 1988;;148:1177-1181.
35 +
Committee on Prevention of Rheumatic Fever and Bacterial Endocarditis of the American Heart Association.  Prevention of bacterial endocarditis . Circulation. 1977;;56:139A-143A.
36 +
Retchin SM, Fletcher RH, Buescher PC, Waugh RA, Battaglini SW.  The application of official policy: prophylaxis recommendations for patients with mitral valve prolapse . Med Care. 1985;;23:1156-1162.
37 +
Devereux RB.  Diagnosis and prognosis of mitral valve prolapse . N Engl J Med. 1989;;320:1077-1079.
38 +
Yoshida K, Yoshikawa J, Shakudo M, et al.  Color Doppler evaluation of valvular regurgitation in normal subjects . Circulation. 1988;;78:840-847.
39 +
Choong CY, Abascal VM, Weyman J, et al.  Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography . Am Heart J. 1989;;117:636-642.
40 +
Sahn DJ, Maciel BC,  Physiologic valvular regurgitation: Doppler echocardiography and the potential for iatrogenic heart disease . Circulation. 1988;;78:1075-1077.
41 +
Lavie CJ, Klein AL, Seward JB, Tajik AJ.  In correspondence: polycystic kidney disease . N Engl J Med. 1989;;320:737.
42 +
Pitcher DW, Papouchado M, Channer KS, James MA.  Endocarditis prophylaxis: do patients remember advice and know what to do? Br Med J. 1986;;293:1539-1540.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Reid JV.  Mid-systolic clicks . S Afr Med J. 1961;; 35:353-355.
2 +
Barlow JB, Pocock WA, Marchand P, Denny M.  The significance of late systolic murmurs . Am Heart J. 1963;;66:443-452.
3 +
Oakley CM.  Mitral valve prolapse: harbinger of death or variant of normal? Br Med J. 1984;;288: 1853-1854.
4 +
Savage DD, Garrison RJ, Devereux RB, et al.  Mitral valve prolapse in the general population, I: epidemiological features: the Framingham study . Am Heart J. 1983;;106:571-576.
5 +
Procaccli PM, Savron SV, Schreiter SL, Bryson AL.  Prevalence of clinical mitral-valve prolapse in 1169 young women . N Engl J Med. 1976;;294:1086-1088.
6 +
Markiewicz W, Stoner J, London E, Hunt SA, Popp RL.  Mitral valve prolapse in one hundred presumably healthy young females . Circulation. 1976;;53:464-473.
7 +
Darsee JR, Mikolich JR, Nicoloff NB, Lesser LE.  Prevalence of mitral valve prolapse in presumably healthy young men . Circulation. 1979;;59:619-622.
8 +
Levy D, Savage D.  Prevalence and clinical features of mitral valve prolapse . Am Heart J. 1987;; 113:1281-1290.
9 +
Retchin SM, Fletcher RH, Waugh RA.  Endocarditis and mitral valve prolapse: what is the 'risk'? Int J Cardiol. 1984;;5:653-659.
10 +
MacMahon SW, Roberts JK, Kramer-Fox R, Zucker DM, Roberts RB, Devereux RB.  Mitral valve prolapse and infective endocarditis . Am Heart J. 1987;;113:1291-1298.
11 +
Mills P, Rose J, Hollingsworth J, Amara I, Craige E.  Long-term prognosis of mitral valve prolapse . N Engl J Med. 1977;;297:13-18.
12 +
LeBauer EJ, Perloff JK, Keliher TF.  The isolated systolic click with bacterial endocarditis . Am Heart J. 1967;;73:534-537.
13 +
Clemens JD, Horwitz RI, Jaffe CC, Feinstein AR, Stanton BF.  A controlled evaluation of the risk of bacterial endocarditis in persons with mitralvalve prolapse . N Engl J Med. 1982;;307:776-781.
14 +
Hickey AJ, MacMahon SW, Wilcken DEL.  Mitral valve prolapse and bacterial endocarditis: when is antibiotic prophylaxis necessary? Am Heart J. 1985;;109:431-435.
15 +
Devereux RB, Hawkins I, Kramer-Fox R, et al.  Complications of mitral valve prolapse: disproportionate occurrence in men and older patients . Am J Med. 1986;;81:751-758.
16 +
MacMahon SW, Hickey AJ, Wilcken DEL, Wittes JT, Feneley MP, Hickie JB.  Risk of infective endocarditis in mitral valve prolapse with and without precordial systolic murmurs . Am J Cardiol. 1987;;59:105-108.
17 +
Danchin N, Voiriot P, Briancon S, et al.  Mitral valve prolapse as a risk factor for infective endocarditis . Lancet. 1989;;1:743-745.
18 +
Nishimura RA, McGoon MD, Shub C, Miller FA Jr, Ilstrup DM, Tajik AJ.  Echocardiographically documented mitral-valve prolapse: long-term follow-up of 237 patients . N Engl J Med. 1985;; 313:1305-1309.
19 +
Marks AR, Choong CY, Sanfilippo AJ, Ferré M, Weyman AE.  Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse . N Engl J Med. 1989;;320:1031-1036.
20 +
Shulman ST, Amren DP, Bisno AL, et al.  Prevention of bacterial endocarditis: a statement for health professionals by the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Disease in the Young . Circulation. 1984;;70:1123-1127.
21 +
Ballard DJ, Khandheria BK, Tajik AJ, Seward JB, Weber V, Melton LJ.  A population-based study of echocardiography: time trends in utilization and diagnostic profile of an evolving technology, 1975-1987 . Int J Technol Assess Health Care . 1989;; 5:249-261.
22 +
Kurland LT, Molgaard CA.  The patient record in epidemiology . Sci Am. 1981;;245:54-63.
23 +
Come PC, Riley MF, Carl LV, Nakao S.  Pulsed Doppler echocardiographic evaluation of valvular regurgitation in patients with mitral valve prolapse: comparison with normal subjects . J Am Coll Cardiol. 1986;;8:1355-1364.
24 +
Panidis IP, McAllister M, Ross J, Mintz GS.  Prevalence and severity of mitral regurgitation in mitral valve prolapse syndrome: a Doppler echocardiographic study of 80 patients . J Am Coll Cardiol. 1986;;7:975-981.
25 +
Helmcke F, Nanda NC, Hsiung MC, et al.  Color Doppler assessment of mitral regurgitation with orthogonal planes . Circulation. 1987;;75:175-183.
26 +
Klein AL, Burstow DJ, Tajik AJ, et al.  Agerelated prevalence of valvular regurgitation in normal subjects—a comprehensive color flow examination of 118 volunteers . J Am Soc Echo. 1989;. In press.
27 +
Harrell FE Jr. The LOGIST Procedure: SUGI Supplemental Library User's Guide, Version 5 Edition. Cary, NC: SAS Institute Inc; 1986:269-293.
28 +
Devereux RB, Kramer-Fox R, Kligfield P.  Mitral valve prolapse: causes, clinical manifestations, and management . Ann Intern Med. 1989;;111:305-317.
29 +
Ballard DJ, Lavie CJ, Taylor CL, Khandheria BK.  Impact of Doppler echocardiography detected mitral regurgitation on endocarditis prophylaxis recommendations: a population-based study . Circulation . 1988;;78( (suppl II) ):II-585. Abstract.
30 +
Steckelberg JM, Melton LJ, Ilstrup DM, Wilson WR.  Influence of referral bias on the apparent clinical spectrum of infective endocarditis . In: Proceedings of the 29th Inter-Science Conference on Antimicrobial Agents and Chemotherapy; September 18, 1989, Houston, Tex .
31 +
Watanakunakorn C.  Changing epidemiology and newer aspects of infective endocarditis . Adv Intern Med. 1976;;22:21-47.
32 +
Terpenning MS, Buggy BP, Kauffman CA.  Infective endocarditis: clinical features in young and elderly patients . Am J Med. 1987;;83:626-634.
33 +
Greenfield S, Blanco DM, Elashoff RM, Ganz PA.  Patterns of care related to age of breast cancer patients . JAMA. 1987;;257:2766-2770.
34 +
Hayward RA, Shapiro MF, Freeman HE, Corey CR.  Who gets screened for cervical and breast cancer? results from a new national survey . Arch Intern Med. 1988;;148:1177-1181.
35 +
Committee on Prevention of Rheumatic Fever and Bacterial Endocarditis of the American Heart Association.  Prevention of bacterial endocarditis . Circulation. 1977;;56:139A-143A.
36 +
Retchin SM, Fletcher RH, Buescher PC, Waugh RA, Battaglini SW.  The application of official policy: prophylaxis recommendations for patients with mitral valve prolapse . Med Care. 1985;;23:1156-1162.
37 +
Devereux RB.  Diagnosis and prognosis of mitral valve prolapse . N Engl J Med. 1989;;320:1077-1079.
38 +
Yoshida K, Yoshikawa J, Shakudo M, et al.  Color Doppler evaluation of valvular regurgitation in normal subjects . Circulation. 1988;;78:840-847.
39 +
Choong CY, Abascal VM, Weyman J, et al.  Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography . Am Heart J. 1989;;117:636-642.
40 +
Sahn DJ, Maciel BC,  Physiologic valvular regurgitation: Doppler echocardiography and the potential for iatrogenic heart disease . Circulation. 1988;;78:1075-1077.
41 +
Lavie CJ, Klein AL, Seward JB, Tajik AJ.  In correspondence: polycystic kidney disease . N Engl J Med. 1989;;320:737.
42 +
Pitcher DW, Papouchado M, Channer KS, James MA.  Endocarditis prophylaxis: do patients remember advice and know what to do? Br Med J. 1986;;293:1539-1540.

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