Increased levels of soluble adhesion molecules, E-selectin and P-selectin,in patients with infective endocarditis and embolic events

Aims Inflammation-induced procoagulant changes and endothelial cell. activa tion appear to play an important role in thromboembolic complications of in fective endocarditis. Hence, the aim of this study was to compare the plasm a levels of soluble adhesion molecules E- and P-selectin in infective endoc arditis patients with and without embolic events, and healthy subjects. Methods and Results The study group consisted of 76 consecutive patients (m ean age = 26 years old, range from 8 to 64 years) with definite infective e ndocarditis according to the Duke criteria. Thirteen of the patients (17.1% ) had embolic events. Transoesophageal echocardiographic examinations were performed on all patients within 3 days of initiation of antimicrobial ther apy. Although there was a trend towards a higher rate of vegetations detect ed in those with embolic events than in those without, this did not reach s tatistical significance (84.6% vs 80.9%, P<0.05). Significantly larger vege tations were observed in patients with embolic events as compared to those without embolic events (1.4 cm vs 1.0 cm, P=0.03). The mean plasma concentr ations of P-selectin were elevated in patients with embolic events as compa red to both patients without embolic events and control subjects(58.69 +/- 7.49 ng. ml(-1) vs 29.65 +/- 5.69 ng. ml(-1), P= <0.001 and 58.69 +/- 7.49 ng. ml(-1) vs 25.82 +/- 5.38 ng.ml(-1), P<0.001). Similarly, the patients w ith embolic events had increased plasma levels of E-selectin compared to th ose without embolic events and the control group (73.15 +/- 11.47 ng.ml(-1) vs 42.84 +/- 8.77 ng. ml(-1), P<0.001 and 73.15 +/- 11.47 ng. ml(-1) vs 34 .23 +/- 5.92 ng. ml(-1), P<0.001). Conclusion Determination of these membrane activation molecules may provide useful markers with which to identify patients at high thromboembolic risk from infective endocarditis. (Eur Heart J 2001; 22: 874-878, doi:10.1053/e uhj.2000.2401) (C) 2001 The European Society of Cardiology.