Right-Sided Infective Endocarditis: The Importance of Vegetation Size.

Area of Science:

• Cardiology
• Infectious Diseases
• Echocardiography

Background:

• Right-sided infective endocarditis (IE) generally has a better prognosis than left-sided IE.
• The prognostic impact of vegetation size in right-sided IE remains less defined.
• This study investigates clinical, microbiological, and echocardiographic factors in right-sided IE to identify predictors of adverse outcomes.

Purpose of the Study:

• To report clinical, microbiological, and echocardiographic findings in isolated right-sided IE.
• To examine predictors of in-hospital mortality, late mortality, and IE recurrence.
• To evaluate the role of vegetation size in right-sided IE prognosis.

Main Methods:

• Retrospective review of 60 consecutive adult patients with isolated right-sided IE.
• Stratification of patients based on intravenous drug user (IVDU) status.
• Recording of culprit organisms, sepsis severity, treatment, complications, and vegetation size; long-term follow-up for mortality and recurrence.

Main Results:

• In-hospital mortality was 3%. Septic emboli occurred in 82% of patients, more common in IVDUs but unrelated to vegetation size.
• Late mortality was predicted by vegetation size >2 cm, chronic kidney disease, and Pitt bacteraemia score.
• Recurrence risk was higher with vegetation >2.5 cm, prisoner status, and multivalvular involvement.

Conclusions:

• Medical management is effective for right-sided IE with small vegetations.
• Large vegetations (>2 cm) are associated with poorer late outcomes and may warrant more aggressive treatment strategies.
• Close follow-up is crucial for patients with right-sided IE, especially those with larger vegetations.