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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Assessing And Managing Embolic Risk in Left-Sided Infective Endocarditis.

J Alberto San Román1, Teresa Sevilla1, Gonzalo Cabezón1

  • 1Cardiology Department, Institute of Heart Sciences (ICICOR), Valladolid, Spain; Centro de investigación biomédica en red Cardiovascular (CIBERCV), Madrid, Spain; Instituto de investigación biomédica de Valladolid (IBioVALL), Valladolid, Spain.

The Canadian Journal of Cardiology
|October 30, 2025
PubMed
Summary
This summary is machine-generated.

Left-sided infective endocarditis carries a high mortality risk. This review suggests evaluating vegetation characteristics beyond size to predict embolic events and guide surgical decisions.

Keywords:
embolismendocarditisstrokevegetation

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Left-sided infective endocarditis (IE) has a high mortality rate (20-30%), exceeding that of many cancers.
  • Vegetations in IE are prone to embolization, leading to embolic events (EE) and significantly increasing mortality, especially when causing stroke.

Purpose of the Study:

  • To review the epidemiology, risk factors, diagnosis, and management of embolic events in infective endocarditis.
  • To propose a shift from a size-centric approach to vegetation assessment for predicting EE risk.
  • To highlight the role of surgery in preventing EE and discuss emerging innovations.

Main Methods:

  • Comprehensive literature review focusing on infective endocarditis, vegetations, and embolic events.
  • Analysis of current guidelines and evidence regarding surgical indications for EE prevention.
  • Exploration of novel diagnostic and therapeutic strategies, including artificial intelligence.

Main Results:

  • Current guidelines recommend surgery for EE prevention based on vegetation presence and size, but evidence supporting size alone is weak.
  • Vegetation characteristics beyond size, alongside clinical and microbiological factors, are crucial determinants of EE risk.
  • Surgery remains a key intervention for preventing embolic events in IE.

Conclusions:

  • A multifactorial approach considering vegetation morphology, clinical presentation, and microbiology is superior to size alone for assessing EE risk.
  • Revising current guidelines to incorporate these broader factors may optimize surgical decision-making and improve patient outcomes.
  • Future directions include leveraging artificial intelligence and minimally invasive techniques for IE management.