Predictors of Visceral Infectious Aneurysms in Patients with Infective Endocarditis and Systemic Embolization.

Abstract

Background: To study whether infective endocarditis patients (IE-patients) with visceral embolic events (VEEs) at admission are at greater risk of developing visceral infectious aneurysms (VIAs) in left-sided infective endocarditis (LSIE) patients.

Methods: We compared the data of prospectively collected 474 consecutive LSIE-patients (2005-2020) with and without VIAs. A whole-body-CTA was part of the initial work-up for all patients.

Results: A total of 24 patients (5.1%) with VIA were included, of whom 19 (79.2%) had at least one VEE, compared to a proportion of 34% (p < 0.001) in IE-patients without VIAs. Both groups also differed in terms of vegetation size (>15 mm: 48% vs. 18%, p < 0.001), microorganisms, Streptococcus spp. (68.5% vs. 42%, p = 0.003), rare microorganisms (36% vs. 8.3%, p < 0.001) and concomitant extra-visceral infectious aneurysms (42% vs. 12.8%, p < 0.001). Cardiac surgery was performed in 21 patients (87.5%) and in-hospital mortality occurred in 2 (8%).

Conclusions: This study shows a different profile of VIA-LSIE patients compared to LSIE-patients without. Streptococcus species were the most frequent causal agents. Our study indicates that the presence of VEEs in LSIE-patients could suggest an increased risk of VIA. This study also shows the need for further abdominal-CTA in all cases of left sided IE to detect asymptomatic visceral aneurysms.