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Systemic embolization in infective endocarditis
Henrik Agerup Kildahl1,2, Evelyn Lauvstad Brenne1, Håvard Dalen2,3
1Department of Cardiothoracic Surgery, St Olavs Hospital, Trondheim, Norway.
Summary
Embolism is a frequent complication of infective endocarditis (IE), impacting 20-40% of patients. While surgery reduces embolism risk, the benefit of treating asymptomatic embolism remains unclear.
Area of Science:
- Cardiology
- Infectious Diseases
- Neurology
Background:
- Embolism is a significant complication of infective endocarditis (IE), leading to severe outcomes like stroke and ischemia.
- Large registries indicate 20-40% of IE patients experience embolism, often at diagnosis.
Purpose of the Study:
- To investigate the incidence of embolism in infective endocarditis patients.
- To evaluate the rate of embolism during hospitalization and post-surgery.
- To assess the clinical significance of asymptomatic embolism in relation to surgical treatment.
Main Methods:
- A comprehensive literature search was conducted.
- A retrospective analysis of 390 infective endocarditis cases diagnosed between 2010 and 2020 at a single center was performed.
Main Results:
- The rate of embolism during hospitalization was 11%, with only 2% developing embolism during or after surgery.
- Routine imaging identified asymptomatic cerebral embolism in 8.5% of patients undergoing surgery.
- Guidelines suggest surgery for IE with prior embolism or vegetations >10 mm.
Conclusions:
- While surgery appears to reduce the risk of embolism during or after the procedure, its impact on overall prognosis needs further investigation.
- The clinical utility of detecting and treating asymptomatic embolism in infective endocarditis patients remains uncertain.
