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Multivalvular vs single-valve infective endocarditis: a systematic review and meta-analysis
Ioannis Kyriakoulis1, Andreas Tzoumas2, Konstantinos G Kyriakoulis3
1Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Background:
Infective endocarditis is characterized by the colonization of heart valves by virulent microorganisms. It commonly manifests as involvement of a single heart valve -single-valve infective endocarditis (SIE), while in some patients, two or more heart valves are concomitantly infected -multivalvular infective endocarditis (MIE). The risk of complications and prognosis of MIE as opposed to SIE are unknown.
Methods:
We performed a systematic search in MEDLINE and Scopus for studies of patients with MIE and SIE. The outcomes of interest included mortality, heart failure, systemic embolic events, and need for surgery.
Results:
Οf 1,124 identified studies, eleven met the inclusion criteria. MIE was reported in 20.4% of the total patients. Compared to SIE, MIE was associated with increased risk of short-term mortality (RR: 1.29, 95% CI: 1.19-1.39), one-year mortality (RR: 1.20, 95% CI: 1.08-1.34), heart failure (RR: 1.31, 95% CI: 1.12-1.54), systemic embolic events (RR: 1.12, 95% CI: 1.02-1.22), and need for subsequent surgical management (RR: 1.22, 95% CI: 1.05-1.41).
Conclusions:
Patients with MIE have a higher likelihood of poor prognosis compared to patients with SIE. A high clinical suspicion of this condition and timely diagnosis and management are imperative while managing patients with infective endocarditis.
Protocol Registration:
PROSPERO CRD42023486674.
Insights
Multivalvular infective endocarditis (MIE) is linked to worse outcomes than single-valve infective endocarditis (SIE). MIE increases risks for mortality, heart failure, and embolic events, necessitating prompt diagnosis and treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) involves heart valve colonization by microorganisms.
- Single-valve infective endocarditis (SIE) is common, while multivalvular infective endocarditis (MIE) affects multiple valves.
- Prognosis and complication risks for MIE versus SIE are not well-established.
Purpose of the Study:
- To compare the clinical outcomes of MIE and SIE.
- To evaluate the association between MIE and adverse events compared to SIE.
Main Methods:
- Systematic literature search of MEDLINE and Scopus databases.
- Inclusion of studies reporting on patients with MIE and SIE.
- Analysis of outcomes including mortality, heart failure, embolic events, and need for surgery.
Main Results:
- MIE was identified in 20.4% of patients across eleven studies.
- MIE significantly increased risks for short-term mortality (RR: 1.29), one-year mortality (RR: 1.20), and heart failure (RR: 1.31).
- MIE was also associated with higher rates of systemic embolic events (RR: 1.12) and need for surgery (RR: 1.22).
Conclusions:
- Multivalvular infective endocarditis portends a poorer prognosis than single-valve infective endocarditis.
- Increased clinical suspicion and timely intervention are crucial for managing MIE.
- Findings highlight the importance of recognizing MIE for improved patient outcomes.
