Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis
Introduction
Systemic arterial embolism which is among the common extracardiac complications in patients with infective endocarditis [1], [2], [3], was reported to occur from 12.9% to 46% of the cases in recent experiences [4], [5], [6], [7], [8], [9], [10], [11], [12], [13] and may carry significant morbidity and mortality [1], [2], [3], [14].
Significant proportion of embolic events in clinical practice occurs before patients seek medical care, therefore prior to institution of effective medical treatment [1] as re-emphasized in studies of 288 patients [10] and 80 patients [11]. In addition, the frequency of emboli was demonstrated to decrease after the beginning of antimicrobial therapy [4], [13], [15]. These data substantiate the hypothesis that arterial embolism is more frequently an early event in the course of the disease. Few recent studies have systematically analyzed the occurrence of systemic arterial embolism in a large series of patients with infective endocarditis in a time-related fashion, more specifically after the beginning of the symptoms of endocarditis.
We evaluated the occurrence of symptomatic systemic arterial embolism after the beginning of symptoms of endocarditis in a large series of patients with infective endocarditis, in order to ascertain its frequency, the time-related distribution and risk factors.
Section snippets
Study design
We retrospectively analyzed an inception cohort of 757 patients with 824 episodes of infective endocarditis treated in a tertiary 423-bed university hospital dedicated mainly to cardiology from October 1978 through November 2001.
The diagnosis of infective endocarditis was made according to previously published criteria [16], [17], [18] and required (1) clinical findings compatible with the disease (fever, predisposing heart disease, new regurgitant murmur, and vascular phenomena); (2) the
Frequency of embolic events and clinical characteristics of the patients with embolism
One hundred forty-six embolic events occurred in 133 (21.1%) out of the 629 patients; 89 (67%) of them were men and 44 (33%) women. Thirteen patients (9.8%) had more than one episode of arterial embolism. Subsequent analysis will be based on the first embolic event.
Embolism involved the central nervous system in 63 (47.4%) patients, peripheral organs in 57 (42.8%) patients, and both central nervous system and peripheral organs in 13 (9.8%) patients.
Embolism to peripheral organs (n = 57) affected
Discussion
The frequency of a first symptomatic embolic event in the present series was 21.1% (133 out of 629 patients), a rate that is in the broad range of the more recently reported rates of embolism in patients with infective endocarditis between 12.9% to 46% of the cases in recent experiences [4], [5], [6], [7], [8], [9], [10], [11], [12], [13].
Recurrence of embolism was found in 9.8% (6 out 133) of the patients, suggesting that this occurrence was a less frequent event with current treatment. This
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