Assessing And Managing Embolic Risk in Left-Sided Infective Endocarditis

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.