Abstract
Introduction: Infective endocarditis (IE) is a life-threatening infection with an annual mortality of 40%. Embolic events reported in up to 80% of patients. Vegetations of > 10 mm size are associated with increased embolic events and poor prognosis. There is a paucity of literature on the association of multiple vegetations with outcomeHypothesis: We aimed to study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetationsMethods: In this retrospective, single-center, case-control study patients diagnosed with IE were recruited from June 2017 to June 2019. A total of 84 patients were diagnosed to have IE, of whom 67 with vegetation were identified. Baseline demographic, clinical, laboratory, and ECHO parameters were reviewed. Outcomes that were studied included recurrent admission, embolic phenomenon, and mortality. Results: Twenty-three (34%) patients were noted to have multiple vegetations, 13 (56.5 %) were male and 10 (43.5%) were female. The mean age of these patients was 50. Eight (35%) had a prior episode of IE. ECHO features of moderate to severe valvular regurgitation (OR:4), presence of pacemaker lead (OR:4.8), impaired LV relaxation, (OR:4), and elevated PASP (OR:2.2) are associated with higher odds of multiple vegetations. Of these moderate to severe valvular regurgitation (p: 0.028), pacemaker lead (p-0.039) and impaired relaxation (p-0.028) were statistically significant. These patients were noted to have an increased association of recurrent admissions (OR:3.6), recurrent bacteremia (OR:2.4), embolic phenomenon (OR:2.5), ICU stay (OR:2.8), hypotension (OR:2.1), surgical intervention (OR:2.8) and device removal (OR:4.8). Of this device removal (p-0.039) and recurrent admissions (0.017) were statistically significantConclusions: This study highlights the associations of echocardiographic predictors and outcomes in patients with IE having multiple vegetations. ECHO features of moderate to severe regurgitation, presence of pacemaker lead, impaired LV relaxation, and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations
Published Version
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