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Bilateral valvular involvement in infective endocarditis: A clinically distinct entity? A multicenter retrospective
Ruchi Bhandari1, Nathan L Maris2,3, Rowida Mohamed4
1West Virginia University School of Public Health, Morgantown, West Virginia, United States of America.
Plos One
|November 21, 2025
Summary
Bilateral infective endocarditis (IE) presents unique challenges, combining risks from substance use and medical complexity. This distinct subgroup requires specific attention in future IE research and clinical practice.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Infective endocarditis (IE) is a serious cardiac infection with significant morbidity and mortality.
- Valvular involvement in IE varies, impacting risk factors and disease severity.
- Understanding these variations is crucial for effective patient management.
Purpose of the Study:
- To describe patient characteristics and outcomes based on valvular involvement in infective endocarditis.
- To analyze differences between Left-sided (LSIE), Right-sided (RSIE), and Bilateral Infective Endocarditis (BLIE).
Main Methods:
- Retrospective multicenter study of 726 adult IE patients (2014-2018).
- Data collected via electronic medical chart review.
- Analysis categorized IE by valvular involvement (LSIE, RSIE, BLIE) and examined associations with ICU admission using logistic regression.
Main Results:
- Drug use, comorbidities, and BLIE/LSIE were linked to increased ICU admission odds.
- BLIE patients faced higher clinical burden: more specialist consultations, pain management, higher mortality, and surgical intervention rates.
- Patient characteristics, comorbidities, substance use, and outcomes differed significantly across LSIE, RSIE, and BLIE.
Conclusions:
- Bilateral infective endocarditis (BLIE) is a distinct IE subgroup.
- BLIE combines high-risk substance use (RSIE) with medical complexity (LSIE).
- BLIE warrants classification as a separate category in future IE research and clinical studies.
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