Clinical and echocardiographic predictors of embolism in infective endocarditis: systematic review and meta-analysis

Yang, Alvin; Tan, Chee Eng; Daneman, Nick; Hansen, Mark; Habib, Gilbert; Salaün, Erwan; Lavoûte, Cécile; Hubert, Sandrine; Adhikari, Neill K. J.

doi:10.1016/j.cmi.2018.08.010

Cited by 37 publications

(34 citation statements)

References 67 publications

(128 reference statements)

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“…IE is often accompanied by complications [2,3], primarily the systemic embolic events due to migrating endocardial vegetations [14]. In a recent meta-analysis, embolism was significantly higher in intravenous drug users, HIVand chronic liver disease patients, during staphylococcal infections, and with multiple, mobile, or mitral valve vegetations, and when the vegetation size is over 10 mm, or in PVE patients [22]. These parameters were exceedingly common in our cohort with the resultant arterial emboli in 44.4% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Portraying infective endocarditis: results of multinational ID-IRI study

Erdem¹,

Puca

Ruch

et al. 2019

Eur J Clin Microbiol Infect Dis

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Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulasenegative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042). a Including all NVE, PVE, pacemaker, and catheter port endocarditis patients. b N indicates the denominator with any identified pathogen. c Coxiella burnetii seropositivity; anti-phase 1 IgG antibody titer ≥ 1:800 A P value of <0.05 was considered significant Eur J Clin Microbiol Infect Dis

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Section: Discussionmentioning

confidence: 99%

Portraying infective endocarditis: results of multinational ID-IRI study

Erdem¹,

Puca

Ruch

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…The incidence of EE was significantly higher in patients exhibiting mobile vegetations. It is not surprising that mobile vegetation can lead to a higher risk of EE, which has been proven by multiple studies over the past several years 18 …”

Section: Predictors For Eementioning

confidence: 94%

“…A meta‐analysis reviewing 23 studies proved that a higher EE risk existed in IE patients with vegetations on the mitral valve versus the aortic valve 18 . Another study noted that vegetations attached to the anterior mitral leaflet were associated with a higher incidence of embolism 19 .…”

Section: Predictors For Eementioning

confidence: 99%

Infective endocarditis complicated by embolic events: Pathogenesis and predictors

Wang

2021

Clinical Cardiology

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Background Infective endocarditis (IE) continues to be associated with great challenges. Embolic events (EE) are frequent and life‐threatening complications in IE patients. It remains challenging to predict and assess the embolic risk in individual patients with IE accurately. Hypothesis Accurate prediction of embolization is critical in the early identification and treatment of risky and potentially embolic lesions in patients with IE. Methods We searched the PubMed, Web of Science, and Google Scholar databases using a range of related search terms, and reviewed the literatures about the pathogenesis and embolic predictors of IE. Results The development of IE and its complications is widely accepted as the result of complex interactions between microorganisms, valve endothelium, and host immune responses. The predictive value of echocardiographic characteristics is the most powerful for EE. In addition, both easily obtained blood biomarkers such as C‐reactive protein, mean platelet volume, neutrophil‐to‐lymphocyte ratio, anti‐β2‐glycoprotein I antibodies, D‐Dimer, troponin I, matrix metalloproteinases, and several microbiological or clinical characteristics might be promising as potential predictors of EE. Conclusion Our review provides a synthesis of current knowledge regarding the pathogenesis and predictors of embolism in IE along with a review of potentially emerging biomarkers.

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“…Major predictors of embolism in IE are intravenous drug use, Staphylococcus aureus infection, mitral valve vegetation, and vegetation size >10 mm. 5 CAE is a rare, but lethal, complication of IE with high morbidity and mortality. Previous observational studies showed that the incidence rate of CAE in IE was approximately 0.5%.…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction as the first sign of infective endocarditis: a case report

et al. 2020

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Infective endocarditis is a bacterial or fungal infection of the heart valves or endocardial surface, and it frequently forms vegetation and can lead to systemic embolism. Dislodged vegetation rarely results in coronary artery embolism (CAE) and subsequent acute myocardial infarction. A 43-year-old male patient was emergently brought to our hospital for suspected acute myocardial infarction. Coronary angiography was performed and it showed embolism in the left circumflex artery. Thrombus aspiration was performed during coronary angiography. Echocardiography showed formation of vegetation in the posterior leaflet of the mitral valve and multiple blood cultures showed Listeria monocytogenes. Infective endocarditis was diagnosed. Three weeks later, debridement of subacute bacterial endocarditis, mitral valve replacement, and tricuspid valvuloplasty were successfully conducted. Our findings suggest that CAE should be considered in the differential diagnosis of acute myocardial infarction. Aspiration of coronary embolus during coronary angiography followed by surgical intervention of diseased heart valves is a plausible strategy for managing CAE in infective endocarditis.

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Clinical and echocardiographic predictors of embolism in infective endocarditis: systematic review and meta-analysis

Abstract: Given the serious consequences of embolism, surgical evaluation may be considered in patients with these risk factors.

Cited by 37 publications

References 67 publications

Portraying infective endocarditis: results of multinational ID-IRI study

Portraying infective endocarditis: results of multinational ID-IRI study

Infective endocarditis complicated by embolic events: Pathogenesis and predictors

Acute myocardial infarction as the first sign of infective endocarditis: a case report

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