SPC365

Infective Endocarditis – Predictors of Cerebral and Peripheral Embolization and Mortality

Session: SESSÃO DE POSTERS 12 - ENDOCARDITE INFECIOSA 1
Speaker: Fernando Nascimento Ferreira

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Fernando Nascimento Ferreira; Francisco Albuquerque; Rita Ilhão Moreira; Barbara Teixeira; Miguel Figueiredo; Madalena Coutinho Cruz; Ana Galrinho; Ana Teresa Timóteo; Pedro Rio; Luísa Moura Branco; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Infective Endocarditis (IE) is a globally impactful pathology with significant incidence and mortality. Among various complications, cerebral and peripheral embolization bear prognostic significance, therefor, there is a need for the assessment of clinical features associated with an increased risk of these complications.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong> To evaluate potential predictors of cerebral and peripheral embolization and their prognostic value.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methodology:</strong> A retrospective study included patients with a definitive diagnosis of IE, according to the 2023 European Society of Cardiology guidelines, who underwent transesophageal echocardiography at a Cardiology Center of a tertiary hospital between 2015 and 2020. Clinical, echocardiographic and prognostic characteristics were assessed, and their association with cerebral (CE) and peripheral embolization (PE), as well as their relationship between those complications and mortality. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 142 patients were included in the study. 71.1% were male, with a mean age of 66 years (&plusmn;15.6). 41.5% had prior cardiac surgery, 37.3% with valve replacement, 32.4% with recent hospitalization or an invasive procedure within the 3 months preceding diagnosis, and 9.9% with a history of bacterial IE. The aortic valve was the most affected (54.9%), and vegetation was the most frequent echocardiographic finding (93.7%).&nbsp;<strong>Staphylococcus spp.</strong>&nbsp;was the predominant microorganism, present in 26.1% of cases.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Complications included heart failure (27.5%), central embolization (CE) (14.8%), 76,2% ischemic, and pulmonary embolism (PE) in 20.4%. Surgical indication were present in 54.2% of patients, and 37% underwent surgery. The in-hospital mortality rate was 23.2%, while the one-year mortality rate was 27.4%.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">PE was significantly associated with tricuspid valve endocarditis (OR 3.7; CI 1.047&ndash;13.186; p=0.047) and IE related to cardiac devices (OR 0.858; CI 0.796&ndash;0.925; p=0.047), both statistically independent. Additionally, PE was found to be a predictor of mortality, though not independently. CE was significantly associated with a history of HF (OR 3.165; CI 1.215&ndash;8.244; p=0.002), clinically complicated HF (OR 3.7; CI 1.047&ndash;13.186; p=0.047), and IE associated with cardiac devices (OR 2.884; CI 1.112&ndash;7.477; p=0.025), all independent associations. CE was strongly correlated to all-cause mortality (OR 4.535; CI 1.640&ndash;12.542; p=0.002), independently of previous mentioned factors.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> The study findings indicate that predictors of PE are tricuspid valve IE and cardiac device-associated IE. Predictors of CE include a history of heart failure, EI complicated with heart failure, and cardiac device-associated IE. Both complications appear to increase mortality. In summary, recognizing clinical features associated with a poorer prognosis allows a meticulous follow-up and early identification of severe IE complications. </span></span></span></p>