title: Incidence and Predictors of Infective Endocarditis in Mitral Valve Prolapse: A Population-Based Study.
abstract: OBJECTIVE
  To determine the incidence and predictors of infective endocarditis (IE) in a population-based cohort of patients with mitral valve prolapse (MVP).
  
  
  METHODS
  We identified all adult Olmsted County residents with MVP diagnosed by echocardiography from January 1989 to December 1998 and cross-matched them with the Rochester Epidemiology Project-identified Olmsted County cases of IE from January 1, 1986, through December 31, 2006. We retrospectively analyzed and de novo confirmed each IE case using the modified Duke criteria.
  
  
  RESULTS
  There were 896 Olmsted County residents with echocardiographically diagnosed MVP (mean age, 53±21 years; 565 women [63%]). The mean follow-up period was 11±5 years. The 15-year cohort risk of IE after MVP diagnosis was 1.1%±0.4% (incidence, 86.6 cases per 100,000 person-years; 95% CI, 43.3-173.2 cases per 100,000 person-years); thus, the age- and sex-adjusted relative risk of IE in patients with MVP was 8.1 (95% CI, 3.6-18.0) in comparison to the general population of Olmsted County (P<.001). There were no IE cases in patients without previously diagnosed mitral regurgitation (MR). Conversely, IE incidence was higher in patients with MVP with moderate, moderate-severe, or severe MR (289.5 cases per 100,000 person-years; 95% CI, 108.7-771.2 cases per 100,000 person-years; P=.02 compared with trivial, mild, or mild-moderate MR) and in patients with a flail mitral leaflet (715.5 cases per 100,000 person-years; 95% CI, 178.9-2861.0 cases per 100,000 person-years; P=.02 compared with no flail mitral leaflet).
  
  
  CONCLUSIONS
  The population-based incidence of IE in adults with MVP is higher than those previously reported in case-control, tertiary care center studies. Patients with MVP and moderate, moderate-severe, or severe MR or a flail mitral leaflet are at a notable risk of developing IE in comparison with those without MR.
authors: Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Ognjen
authors: O
authors: Katan
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Electronic address: michelena.hector@mayo.edu.
authors: Hector I
authors: HI
authors: Michelena
authors: La Timone Hospital, Marseille, France.
authors: Jean-Francois
authors: JF
authors: Avierinos
authors: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors: Douglas W
authors: DW
authors: Mahoney
authors: Division of Infectious Diseases, Mayo Clinic, Rochester, MN.
authors: Daniel C
authors: DC
authors: DeSimone
authors: Division of Infectious Diseases, Mayo Clinic, Rochester, MN.
authors: Larry M
authors: LM
authors: Baddour
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
authors: Rakesh M
authors: RM
authors: Suri
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: Maurice
authors: M
authors: Enriquez-Sarano
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography; D004696:Endocarditis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D008945:Mitral Valve Prolapse / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors