Fatores associados a eventos embólicos na endocardite infecciosa: análise dos casos do Instituto Nacional de Cardiologia entre os anos 2006 e 2011
Fatores associados a eventos embólicos na endocardite infecciosa: análise dos casos do Instituto Nacional de Cardiologia entre os anos 2006 e 2011
Data
2015
Autores
Monteiro, Thaíssa Santos
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução. As complicações embólicas são frequentes na endocardite infecciosa (EI) e agregam maior morbimortalidade. Contudo, as implicações dos eventos embólicos assintomáticos ainda são incertas. Informações sobre o comportamento da EI em países em desenvolvimento são escassos. Objetivos. O objetivo principal foi avaliar a frequência e gravidade dos eventos embólicos secundários a EI. O objetivo secundário foi descrever o perfil dos pacientes com EI. Métodos. Estudo retrospectivo incluindo 136 pacientes adultos com EI definitiva internados no Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil,de 2006 a 2011. Foi realizada análise bivariada e multivariada para estabelecer fatores associados a eventos embólicos na EI. Resultados. A valvopatia reumática (VR) foi um fator predisponente em 51/127 (40,1%) dos pacientes. A complicação mais frequente observada foi a insuficiência cardíaca 75/136 (55,1%), seguida do evento embólico (50%, n=68). Dos 112 prontuários analisados quanto a eventos embólicos assintomáticos, observou-se que 32,1% (n=36) dos pacientes tiveram um evento embólico assintomático, sendo 9,8% (n=11) para o SNC e 25% (n=28) para o baço. Esplenectomia foi realizada em 18,7% (n=21). Cirurgia cardíaca foi realizada em 98/132 (74,2%). Na análise bivariada, a esplenomegalia e a EI da valva mitral foram fatores associados para eventos embólicos quaisquer, para o SNC e para o baço. Na análise multivariada, a esplenomegalia foi o único fator associado a evento embólico para qualquer sítio (p<0,01, OR 4,7, IC 2,04-11). Na embolia para baço, a esplenomegalia foi um dos fatores associados (p<0,01, OR 9,2, IC 3,32-29) assim como a presença de hemocultura positiva (p=0,05, OR 8,9, IC 1,45-177). A EI de valva mitral (p<0,05, OR 3,5, IC 1,23-10) e o sexo masculino (p<0,05, OR 3,2, IC 1,04-10) foram associados à embolia para o SNC. A realização de esplenectomia ou cirurgia cardíaca não teve impacto na mortalidade intra-hospitalar. Conclusão. A VR ainda é um importante fator de risco para EI na população estudada. A esplenomegalia foi um fator associado para eventos embólicos . Os eventos embólicos assintomáticos para o SNC e para o baço foram frequentes e resultaram na realização de esplenectomia antes da cirurgia cardíaca, mas não mostraram aumento na mortalidade intra-hospitalar.
Introduction. Embolic complications of infective endocarditis (IE) are common and increase morbidity and mortality. However, the implication of asymptomatic embolism is uncertain. Information about the behavior of IE in developing countries is scarce. Objectives. The primary objective was to determine the frequency and severity of emboli due to IE. The secondary objective was to describe the profile of patients with IE. Methods. Retrospective study including 136 adult patients that were hospitalized in Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil, with definite IE from 2006 to 2011. Bivariate and multivariate analyses were done to search for factors associated with embolism in IE. Results. Rheumatic valve disease (RVD) was a predisposition factor in 51/127 of patients (40,1%). The most common complication was heart failure (55,1%, n=75), followed by embolism (50%, n=68). Among the 112 medical records analyzed in search of asymptomatic embolism, 32,1% (n=36) of patients were found to have had asymptomatic embolism, with 9,8% (n=11) of these being a central nervous system (CNS) embolic events and 25% (n=28) splenic emboli. Splenectomy was performed in 18,7% (n=21). Cardiac surgery was done in 98/132 (74,2%). In the bivariate analysis, splenomegaly and IE of the mitral valve were factors associated to embolism to any site, to the CNS and to the spleen. In the multivariate analysis, splenomegaly was the only associated factor for embolism to any site (p<0,01, OR 4,7, CI 2,04-11) and was one of the factors for embolism to the spleen (p<0,01, OR 9,2, CI 3,32-29), as well as positive blood cultures (p=0,05, OR 8,9, CI 1,45-177); IE of the mitral valve (p<0,05, OR 3,5, CI 1,23-10) and male gender (p<0,05, OR 3,2, CI 10 1,04-10) were associated with embolism to the CNS. Splenectomy and cardiac surgery did not have an impact of in-hospital mortality. Conclusion. RVD is still an important risk factor for IE in the studied population.Splenomegaly was associated with embolic events. Asymptomatic embolism to the CNS and to the spleen were frequent and resulted in splenectomy before cardiac surgery, however neither surgical procedure showed increased in-hospital mortality.
Introduction. Embolic complications of infective endocarditis (IE) are common and increase morbidity and mortality. However, the implication of asymptomatic embolism is uncertain. Information about the behavior of IE in developing countries is scarce. Objectives. The primary objective was to determine the frequency and severity of emboli due to IE. The secondary objective was to describe the profile of patients with IE. Methods. Retrospective study including 136 adult patients that were hospitalized in Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil, with definite IE from 2006 to 2011. Bivariate and multivariate analyses were done to search for factors associated with embolism in IE. Results. Rheumatic valve disease (RVD) was a predisposition factor in 51/127 of patients (40,1%). The most common complication was heart failure (55,1%, n=75), followed by embolism (50%, n=68). Among the 112 medical records analyzed in search of asymptomatic embolism, 32,1% (n=36) of patients were found to have had asymptomatic embolism, with 9,8% (n=11) of these being a central nervous system (CNS) embolic events and 25% (n=28) splenic emboli. Splenectomy was performed in 18,7% (n=21). Cardiac surgery was done in 98/132 (74,2%). In the bivariate analysis, splenomegaly and IE of the mitral valve were factors associated to embolism to any site, to the CNS and to the spleen. In the multivariate analysis, splenomegaly was the only associated factor for embolism to any site (p<0,01, OR 4,7, CI 2,04-11) and was one of the factors for embolism to the spleen (p<0,01, OR 9,2, CI 3,32-29), as well as positive blood cultures (p=0,05, OR 8,9, CI 1,45-177); IE of the mitral valve (p<0,05, OR 3,5, CI 1,23-10) and male gender (p<0,05, OR 3,2, CI 10 1,04-10) were associated with embolism to the CNS. Splenectomy and cardiac surgery did not have an impact of in-hospital mortality. Conclusion. RVD is still an important risk factor for IE in the studied population.Splenomegaly was associated with embolic events. Asymptomatic embolism to the CNS and to the spleen were frequent and resulted in splenectomy before cardiac surgery, however neither surgical procedure showed increased in-hospital mortality.
Description
Palavras-chave
Endocardite infecciosa, Embolia séptica, Embolia assintomática, Epidemiologia, Cirurgia cardíaca, Esplenectomia, Infective endocarditis, Septic embolism, Asymptomatic embolism, Epidemiology, Cardiac surgery, Splenectomy
Citação
Monteiro TS. Fatores associados a eventos embólicos na endocardite infecciosa: análise dos casos do Instituto Nacional de Cardiologia entre os anos 2006 e 2011. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2015.