Clinical Case of a Patient with Acute Tricuspid Valve Infective Endocarditis and A Multiplex Approach to Evaluation of The Complication Risk
E. O. Kotova,
Zh. D. Kobalava,
A. S. Pisaryuk,
A. V. Lokhonina,
A. Y. Moiseeva,
E. A. Domonova,
J. I. Babukhina,
P. V. Kakhktsyan,
Т. Kh. Fatkhudinov https://doi.org/10.20514/2226-6704-2025-15-1-57-67
EDN: ROWZXY
Abstract
Infective endocarditis (IE) is characterized by the difficulty of diagnosis, treatment and risk assessment of an unfavorable prognosis. Currently there are no approved scales and calculators for the risk of complications and death that help the practitioner make decisions, especially in patients with isolated right-sided IE. For right-sided IE, the timing of successful surgical treatment remains uncertain. Previously developed risk calculators (Italian Rizzi calculator and French Hubert) are poorly validated in a wide population of patients with IE, especially for right-sided IE. One of the required parameters of calculators is the determination of etiological affiliation. However, with negative results of microbiological studies reaching 56-83 %, this parameter becomes uninformative. Moreover, existing risk assessment tools do not take into account the activity of the disease (including laboratory activity), which intuitively is an important guideline for every doctor in decision-making. At the moment, there is a great need for the introduction of molecular biological methods to improve the quality of etiological diagnosis and in-depth study of possible biomarkers from simple (neutrophil/lymphocytic, platelet/lymphocytic and systemic immuno-inflammatory index) to more complex (neutrophil extracellular traps, cytokine profile). We present a clinical case of a young patient with acute tricuspid valve IE with giant vegetation (28 mm), complicated by severe valvular insufficiency without signs of heart failure, recurrent embolic syndrome in the pulmonary artery system with the formation of pulmonary hypertension, determining indications for cardiac surgical treatment. The etiological affiliation of IE to Staphylococcus aureus was established only by PCR. The urgent timing of intervention was determined based on an increase in new markers — neutrophil/lymphocytic index ≥20.0, systemic immuno-inflammatory index ≥2314.0 and neutrophil extracellular traps ≥14.2, indicating an extremely high risk of death. A fundamental pathohistological study of the tissue material revealed a low content of intact CD86+ proinflammatory macrophages, probably associated with their excessive destruction and uncontrolled release of copious amounts of proinflammatory cytokines, which led to rapid and severe damage to the tricuspid valve. Thus, modern management of patients with IE should be multiplex using current methods of etiological and imaging diagnostics, and aimed at early detection of patients at adverse risk for a timely differentiated approach to conservative or cardiac surgical treatment tactics.
Keywords
infective endocarditis,
prognosis,
tricuspid valve,
neutrophil-lymphocyte index,
neutrophil extracellular traps,
PCR
Supporting agencies: The work was supported by a grant from the Russian Science Foundation (project No. 22-75-10012) using human biomaterial collected and stored within the framework of the scientific program. Equipment for collecting, storing and transporting human biomaterial, equipment for examining patients was purchased using funds from the RUDN University Strategic Academic Leadership Program
About the Authors
E. O. Kotova
Peoples’ Friendship University of Russia named after Patrice Lumumba;
University Clinical Hospital named after V.V. Vinogradov (branch) of the Peoples’ Friendship University of Russia named after Patrice Lumumba;
Federal Budget Institution of Science Central Research Institute of Epidemiology of The Federal Service on Customer’s Rights Protection and Human Well-being Surveillance
Russian Federation
Russian Federation
Elizaveta O. Kotova — PhD, associate professor of the department of internal diseases with the course in cardiology and functional diagnostics named after V.S. Moiseev, Medical Institute, FGAOU VO People`s Friendship University of Russia named after Patrice Lumumba (RUDN University), consultant of the organizational and methodological department of the administrative and management unit of the Federal Budgetary Scientific Institution Central Research Institute of Epidemiology of Rospotrebnadzor; cardiologist of the University Clinical Hospital named after V.V. Vinogradov
Moscow
Zh. D. Kobalava
Peoples’ Friendship University of Russia named after Patrice Lumumba;
University Clinical Hospital named after V.V. Vinogradov (branch) of the Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Zhanna D. Kobalava — correspondent member of Russian academy of science, M.D., PhD, professor, Head of the department of the internal diseases with the course in cardiology and functional diagnostics named after V.S. Moiseev, Medical Institute, FGAOU VO People`s Friendship University of Russia named after Patrice Lumumba (RUDN University)
Moscow
A. S. Pisaryuk
Peoples’ Friendship University of Russia named after Patrice Lumumba;
University Clinical Hospital named after V.V. Vinogradov (branch) of the Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Aleksandra S. Pisyaryuk — PhD, cardiologist of the University Clinical Hospital named after V.V. Vinogradov.; associate professor of department of the internal diseases with the course in cardiology and functional diagnostics named after V.S. Moiseev, Medical Institute, FGAOU VO People`s Friendship University of Russia named after Patrice Lumumba (RUDN University)
Moscow
A. V. Lokhonina
Peoples’ Friendship University of Russia named after Patrice Lumumba;
Laboratory of Growth and Development, Avtsyn Research Institute of Human Morphology of FSBI Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Anastasiya V. Lokhonina — PhD, assistant at the Department of Histology, Cytology and Embryology, Medical Institute, FGAOU VO People`s Friendship University of Russia named after Patrice Lumumba (RUDN University)
Moscow
A. Y. Moiseeva
Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Alexandra Yu. Moiseeva — PhD, assistant of the department of internal diseases with the course in cardiology and functional diagnostics named after V.S. Moiseev, Medical Institute
Moscow
E. A. Domonova
Federal Budget Institution of Science Central Research Institute of Epidemiology of The Federal Service on Customer’s Rights Protection and Human Well-being Surveillance
Russian Federation
Russian Federation
Elvira A. Domonova — PhD in biology, Head of the scientific group for the development of new methods for diagnosis of opportunistic and human papillomavirus infections in the Department of Molecular Diagnostics and Epidemiology Central Research Institute of Epidemiology
Moscow
J. I. Babukhina
Federal State Budget Institution «A.N. Bakulev National Medical Research Center of Cardiovascular Surgery» of the Ministry of Health of the Russian Federation (A.N. Bakulev NMRCVS)
Russian Federation
Russian Federation
Julia I. Babukhina — cardiologist, junior researcher at the consultative and diagnostic center of the Institute of Coronary and Vascular Surgery of
Moscow
P. V. Kakhktsyan
Federal State Budget Institution «A.N. Bakulev National Medical Research Center of Cardiovascular Surgery» of the Ministry of Health of the Russian Federation (A.N. Bakulev NMRCVS)
Russian Federation
Russian Federation
Pavel V. Kakhktsyan — PhD, Head of the Department of Reconstructive Surgery of Heart Valves and Coronary Arteries, cardiovascular surgeon, leading researcher
Moscow
Т. Kh. Fatkhudinov
Peoples’ Friendship University of Russia named after Patrice Lumumba;
Laboratory of Growth and Development, Avtsyn Research Institute of Human Morphology of FSBI Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Timur Kh. Fatkhudinov — Doctor of Medical Sciences, Professor, Head of the Department of Histology, Cytology and Embryology, Medical Institute, FGAOU VO People`s Friendship University of Russia named after Patrice Lumumba (RUDN University)
Moscow
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For citations:
Kotova E.O., Kobalava Zh.D., Pisaryuk A.S., Lokhonina A.V., Moiseeva A.Y., Domonova E.A., Babukhina J.I., Kakhktsyan P.V., Fatkhudinov Т.Kh. Clinical Case of a Patient with Acute Tricuspid Valve Infective Endocarditis and A Multiplex Approach to Evaluation of The Complication Risk. The Russian Archives of Internal Medicine. 2025;15(1):57-67. https://doi.org/10.20514/2226-6704-2025-15-1-57-67. EDN: ROWZXY
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