The Brazilian Journal of Infectious Diseases The Brazilian Journal of Infectious Diseases
Braz J Infect Dis 2017;21:240-7 - Vol. 21 Num.3 DOI: 10.1016/j.bjid.2017.01.006
Original article
Asymptomatic and symptomatic embolic events in infective endocarditis: associated factors and clinical impact
Thaíssa S. Monteiroa, Marcelo G. Correiab, Wilma F. Golebiovskia, Giovanna Ianini F. Barbosac, Clara Wekslera, Cristiane C. Lamasa,d,e,,
a Instituto Nacional de Cardiologia, Departamento de Doenças da Válvula Cardíaca, Rio de Janeiro, RJ, Brazil
b Instituto Nacional de Cardiologia, Departamento de Bioestatística, Rio de Janeiro, RJ, Brazil
c Instituto Nacional de Cardiologia, Unidade de Controle de Infecções, Rio de Janeiro, RJ, Brazil
d Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil
e Universidade do Grande Rio (Unigranrio), Rio de Janeiro, RJ, Brazil
Received 02 July 2016, Accepted 17 January 2017
Abstract
Background

Embolic complications of infective endocarditis are common. The impact of asymptomatic embolism is uncertain.

Objectives

To determine the frequency of emboli due to IE and to identify events associated with embolism.

Methods

Retrospective analysis of an endocarditis database, prospectively implemented, with a post hoc study driven by analysis of data on embolic events. Data was obtained from the International Collaboration Endocarditis case report forms and additional information on embolic events and imaging reports were obtained from the medical records. Variables associated with embolism were analyzed by the statistical software R version 3.1.0.

Results

In the study period, 2006–2011, 136 episodes of definite infective endocarditis were included. The most common complication was heart failure (55.1%), followed by embolism (50%). Among the 100 medical records analyzed for emboli in left-sided infective endocarditis, 36 (36%) were found to have had asymptomatic events, 11 (11%) to the central nervous system and 28 (28%) to the spleen. Cardiac surgery was performed in 98/136 (72%). In the multivariate analysis, splenomegaly was the only associated factor for embolism to any site (p<0.01, OR 4.7, 95% CI 2.04–11). Factors associated with embolism to the spleen were positive blood cultures (p=0.05, OR 8.9, 95% CI 1.45–177) and splenomegaly (p<0.01, OR 9.28, 95% CI 3.32–29); those associated to the central nervous system were infective endocarditis of the mitral valve (p<0.05, OR 3.5, 95% CI 1.23–10) and male gender (p<0.05, OR 3.2, 95% CI 1.04–10). Splenectomy and cardiac surgery did not impact on in-hospital mortality.

Conclusions

Asymptomatic embolism to the central nervous system and to the spleen were frequent. Splenomegaly was consistently associated with embolic events.

Keywords
Infective endocarditis, Embolism, Asymptomatic embolism, Splenomegaly, Cardiac surgery, Splenectomy
Braz J Infect Dis 2017;21:240-7 - Vol. 21 Num.3 DOI: 10.1016/j.bjid.2017.01.006