Evaluation of Systemic Embolism in Patients with Prosthetic Valve Endocarditis: Key Insights and Implications

Prosthetic valve endocarditis (PVE) is a serious complication following heart valve surgery, presenting considerable diagnostic and therapeutic challenges. Despite advances in treatment, systemic embolism remains a major adverse event associated with poor outcomes. This study aimed to identify predictors of in-hospital systemic embolism in patients with PVE and to evaluate treatment outcomes.

This retrospective, single-center study included 96 patients diagnosed with mechanical PVE between 2012 and 2024. Diagnoses were established based on the modified Duke criteria. Data on demographics, comorbidities, clinical presentation, imaging findings, and treatment strategies were collected and analyzed. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were employed to identify risk factors.

The study cohort had a median age of 52.4 years (range 22-82). Systemic embolic events occurred in 39 patients (40.6%), with stroke being the most common manifestation (26%). Multivariate analysis identified vegetation size as the only independent predictor of systemic embolism (odds ratio [OR]: 2.34, P = 0.037). ROC analysis determined a vegetation size threshold of 2 cm², with 66% sensitivity and 78% specificity. Elevated erythrocyte sedimentation rate (ESR) and a prior history of stroke were also associated with increased embolic risk. Among 31 patients who underwent surgery, early intervention did not significantly reduce embolism rates compared to delayed surgery. Successful treatment was associated with a lower risk of embolism (P = 0.045).

Larger vegetations, elevated ESR, and a prior history of stroke are key risk factors for systemic embolism in PVE. Early identification of high-risk patients and implementation of individualized management strategies are essential to improve clinical outcomes. Further multicenter studies are warranted to refine treatment protocols.