Features of infective endocarditis with embolic complications

Abstract

Introduction: Infective Endocarditis (IE) is a severe disease with in-hospital mortality up to 20%, mostly due to embolic complications that increase the risk of death about 3 times. The incidence of cerebral embolism is 17-20% of all patients with IE, while non-cerebral embolism incidence is about 23-27%, both being probably underestimated because of the silent clinical evolution. Methods: Retrospective survey of 94 adults with definite IE admitted in 3 hospitals from November 2008 through January 2012. Results: The average age of the patients was 51,8±0,6 years, including 62% men and 38% women. In our survey 16 (17%) of patients developed embolic episodes, of which cerebral embolism 6.4%, pulmonary embolism 4.3%, kidney embolism 3.2%, splenic embolism 3.2%, retinal embolism 2.1%, extremities embolism 2.1% and cardiac embolism 1.1%. There is a relatively small percentage of cerebral embolism (6,4%) compared with data reported in literature. Embolism detected in one organ had a higher rate of 81.3% (n=16) compared to embolization of two organs 18.8%. Staphylococcus aureus was more commonly detected 12,5% in patients with embolic episodes (n=16) vs. those without embolic complications - 3,8% (n=78). In patients with IE and embolic complications transthoracic echocardiography revealed vegetations in 13 (81,3%) versus 49 (62,8%) in those without embolism. In both groups aortic and mitral valve were more commonly affected, but in patients with IE and embolic conditions mobile vegetations were 1,8 times more frequently (50%) than in patients without embolism (28,2%). Also large vegetations (>20 mm) were observed by 2,5 times more frequently in patients with embolism than in those without embolic complications (12.5% vs. 5.1%). Conclusions: 1.Patients with IE complicated by embolism had more frequently proven mobile valvular vegetations and Staphylococcus aureus infection. 2. In IE, the embolic complications are widely undiagnosed and require imaging investigations (CT, MRI, Doppler investigation) for early diagnosis, initiation of appropriate treatment and prognosis improvement in these patients.