Predictors of Visceral Infectious Aneurysms in Patients with Infective Endocarditis and Systemic Embolization

Area of Science:

• Cardiology
• Infectious Diseases
• Radiology

Background:

• Left-sided infective endocarditis (LSIE) is a serious condition.
• Visceral infectious aneurysms (VIAs) are a potential complication.
• The risk of VIA development in LSIE patients with visceral embolic events (VEEs) is not well understood.

Purpose of the Study:

• To investigate the association between VEEs at admission and the development of VIAs in LSIE patients.
• To identify risk factors and clinical profiles of LSIE patients with VIAs.

Main Methods:

• A prospective cohort study comparing 474 LSIE patients with and without VIAs (2005-2020).
• All patients underwent whole-body CT angiography (CTA) as part of their initial work-up.
• Data on clinical characteristics, microbiology, and outcomes were analyzed.

Main Results:

• 24 patients (5.1%) developed VIAs.
• VEEs were significantly more common in patients with VIAs (79.2% vs. 34%, p < 0.001).
• Larger vegetation size, *Streptococcus* species, rare microorganisms, and concomitant extra-visceral aneurysms were also associated with VIAs.

Conclusions:

• LSIE patients with VEEs have a distinct clinical profile and an increased risk of developing VIAs.
• *Streptococcus* species are the most frequent causative agents.
• Abdominal CTA is recommended for all LSIE patients to detect asymptomatic VIAs.