Asymptomatic and symptomatic embolic events in infective endocarditis: associated factors and clinical impact
Asymptomatic and symptomatic embolic events in infective endocarditis: associated factors and clinical impact
Data
2017
Autores
Monteiro, Thaíssa S.
Correia, Marcelo G.
Golebiovski, Wilma F.
Barbosa, Giovanna Ianini F.
Weksler, Clara
Lamas, Cristiane C.
Journal Title
Journal ISSN
Volume Title
Publisher
Brazilian Journal of Infectious Diseases
Resumo
Background: Embolic complications of infective endocarditis are common. The impact of
asymptomatic embolism is uncertain.
Objectives: To determine the frequency of emboli due to IE and to identify events associated
with embolism.
Methods: Retrospective analysis of an endocarditis database, prospectively implemented,
with a post hoc study driven by analysis of data on embolic events. Data was obtained from
the International Collaboration Endocarditis case report forms and additional information
on embolic events and imaging reports were obtained from the medical records. Variables
associated with embolism were analyzed by the statistical software R version 3.1.0.
Results: In the study period, 2006–2011, 136 episodes of definite infective endocarditis were
included. The most common complication was heart failure (55.1%), followed by embolism
(50%). Among the 100 medical records analyzed for emboli in left-sided infective endocardi-
tis, 36 (36%) were found to have had asymptomatic events, 11 (11%) to the central nervous
system and 28 (28%) to the spleen. Cardiac surgery was performed in 98/136 (72%). In the
multivariate analysis, splenomegaly was the only associated factor for embolism to any
site (p < 0.01, OR 4.7, 95% CI 2.04–11). Factors associated with embolism to the spleen were
positive blood cultures (p = 0.05, OR 8.9, 95% CI 1.45–177) and splenomegaly (p < 0.01, OR 9.28,
95% CI 3.32–29); those associated to the central nervous system were infective endocarditis
of the mitral valve (p < 0.05, OR 3.5, 95% CI 1.23–10) and male gender (p < 0.05, OR 3.2, 95% CI
1.04–10). Splenectomy and cardiac surgery did not impact on in-hospital mortality.
Conclusions: Asymptomatic embolism to the central nervous system and to the spleen were
frequent. Splenomegaly was consistently associated with embolic events.
Description
Palavras-chave
Infective endocarditis, Embolism, Asymptomatic embolism, Splenomegaly, Cardiac surgery, Splenectomy
Citação
Monteiro TS, Correia MG, Golebiovski WF, Barbosa GIF, Weksler C, Lamas CC. Asymptomatic and symptomatic embolic events in infective endocarditis: associated factors and clinical impact. Braz J Infect Dis. 2017 May-Jun;21(3):240-247. doi: 10.1016/j.bjid.2017.01.006.