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Vascular Complications of Infective Endocarditis: Diagnosis and Management

Kissami Ibtisam¹, Mehdi El Bekkaoui², Imane Skiker²

¹Cardiology, Faculty of Medicine and Pharmacy, Centre Hospitalier Universitaire, Mohamed First University, Oujda, MAR.

|May 31, 2021

Insights

Vascular complications are common and severe in infective endocarditis (IE). Splenic infarcts were the most frequent complication in this study, highlighting the need for early diagnosis and management.

Area of Science:

Cardiology
Infectious Diseases
Vascular Medicine

Background:

Infective endocarditis (IE) frequently leads to severe vascular complications.
A significant proportion of IE patients (33.3%) experience vascular issues.
This study analyzes the clinical profile and prognosis of these complications.

Purpose of the Study:

To investigate the clinical and paraclinical profiles of vascular complications in infective endocarditis.
To determine the prognosis of vascular complications associated with IE.
To align management strategies with European Society of Cardiology guidelines for IE.

Main Methods:

Retrospective analysis of 57 patients hospitalized for IE between 2015 and 2020.
Modified Duke University criteria were used for IE diagnosis.
Vascular complications were identified and categorized within the cohort.

Main Results:

Nineteen patients (33.3%) developed one or more vascular complications.
The most common complication was splenic infarct (nine cases), followed by neurological complications (six cases).
Commonly isolated pathogens included Streptococcus and Staphylococcus aureus.

Conclusions:

Vascular complications of IE are severe, with splenic infarct being the most prevalent in this cohort.
Early diagnosis and prevention are crucial for effective management of IE vascular complications.
Long-term follow-up revealed low recurrence and mortality rates, though stroke remains a risk.

Read full analysis

Abstract

Introduction:

The complications of infective endocarditis (IE) are frequent and severe. Our aim was to study the clinical and paraclinical profiles and prognosis of vascular complications, observed in a cardiology unit in Oujda, Morocco. Among 57 patients hospitalized for IE between 2015 and 2020 at the cardiology unit, 19 patients, or 33.3% of patients, had one or more vascular complications. We present here a retrospective analysis.

Aim:

Prevention, early diagnosis, and treatment of vascular complications are primordial to improving prognosis, following the guidelines of the European Society of Cardiology.

Patients And Methods:

We retrospectively studied 57 patients hospitalized for IE. The diagnostic criteria for IE were modified from the Duke University criteria and we present all vascular complications among this cohort.

Results:

Nineteen patients presented with one or more vascular complications, 10 men and nine women, with a mean age of 49 years. IE had grafted on a mechanical prosthetic valve in four cases. Overall, we found 25 vascular lesions: six neurological complications, five cases of peripheral vascular involvement, nine splenic infarcts, and five recurrent septic pulmonary embolisms (SPEs). The vascular complications accrued after three to 14 days of antibiotherapy or on extension reports; blood cultures were positive in 17 (89.4%) cases; streptococcus was isolated in nine cases; Staphylococcus aureus in seven cases; and acinetobacter in one case.

Conclusion:

Vascular complications of IE are severe, the most common in our study being splenic infarct. Prevention and early diagnosis are essential to instituting optimal management. All the patients were followed up with a mean follow-up of three years. Late mortality involved one patient in connection with a hemorrhagic stroke secondary to an accident with vitamin K antagonists after its release in one month. No cases of recurrence of endocarditis were noted in this group. Data were collected from archived medical records and analyzed by Statistical Package for the Social Sciences.

Keywords:

embolic events infective endocarditis mycotic aneurysms vascular complication

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