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Right-sided infective endocarditis and pulmonary embolism: a multicenter study.

Domenico Galzerano1, Valeria Pergola2, Abdulhalim J Kinsara3

  • 1King Faisal Specialist Hospital & Research Centre, Heart Centre, Riyadh; Alfaisal University, College of Medicine, Riyadh. domenicogalzerano@libero.it.

Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace
|April 13, 2022
PubMed
Summary

Right-sided infective endocarditis (RSIE) with large vegetations (>1.5 cm) or Staphylococcus aureus infection warrants routine computed tomography pulmonary angiography (CTPA). This identifies high-risk patients for pulmonary embolism (PE), enabling timely, aggressive treatment to improve outcomes.

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Radiology

Background:

  • Right-sided infective endocarditis (RSIE) incidence is rising, posing a significant risk for embolic events (EE).
  • Identifying patients with RSIE at high risk for pulmonary embolism (PE) is crucial for improving prognosis through targeted therapies.

Purpose of the Study:

  • To identify clinical characteristics of RSIE patients complicated by PE.
  • To determine predictors of significant PE in RSIE patients.

Main Methods:

  • Retrospective analysis of 176 RSIE patients with PE across 6 centers (Jan 2015-Sep 2020).
  • Advanced imaging including CT pulmonary angiography (CTPA) in 28 patients.
  • Transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) for vegetation assessment.

Main Results:

  • Vegetations were frequently found on the native tricuspid valve (71.7%), with a raceme-like morphology (35.8%).
  • Staphylococcus aureus was the most common pathogen (50%).
  • High PE incidence correlated with vegetation length >1.5 cm.

Conclusions:

  • Routine CTPA is recommended for RSIE patients with vegetations >1.5 cm or S. aureus infection.
  • Early identification of high-risk PE patients can guide aggressive treatment strategies.
  • Further prospective studies are needed to validate these findings.