Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2024; 16(6): 318-328
Published online Jun 26, 2024. doi: 10.4330/wjc.v16.i6.318
Echocardiographic predictors and associated outcomes of multiple vegetations in infective endocarditis: A pilot study
Ajay Kumar Mishra, Kannu Bansal, Ibragim Al-Seykal, Pradnya B Bhattad, Anu Anna George, Anil Jha, Nitish Sharma, Jennifer Sargent, Mark J Kranis
Ajay Kumar Mishra, Pradnya B Bhattad, Anil Jha, Nitish Sharma, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
Kannu Bansal, Anu Anna George, Jennifer Sargent, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Ibragim Al-Seykal, Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
Mark J Kranis, Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Author contributions: Mishra AK and Jha A planned and formulated the study; Al-Seykal I, Bhattad PB, and George AA collected and analyzed the data; Mishra AK, Bansal K, George AA, and Jha A completed the manuscript; Mishra AK, Sharma N, Sargent J, and Kranis MJ reviewed the manuscript; Kranis MJ approved the manuscript.
Institutional review board statement: This protocol was developed, reviewed, and sanctioned by the joint institutional review board at MetroWest Medical Center under Approval No. 2019-171.
Informed consent statement: The ethical requirement for individual informed consent was appropriately waived by the institutional review board due to the retrospective nature of this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ajay Kumar Mishra, MD, Academic Fellow, Division of Cardiology, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, United States. ajaybalasore@gmail.com
Received: February 4, 2024
Revised: April 27, 2024
Accepted: May 15, 2024
Published online: June 26, 2024
Processing time: 141 Days and 16.3 Hours
Abstract
BACKGROUND

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 outcome.

AIM

To study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetations.

METHODS

In this retrospective, single-center, cohort 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 [odds ratio (OR) = 4], presence of pacemaker lead (OR = 4.8), impaired left ventricle (LV) relaxation (OR = 4), and elevated pulmonary artery systolic pressure (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), intensive care unit 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 (P = 0.017) were statistically significant.

CONCLUSION

This study highlights the associations of ECHO 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.

Keywords: Endocarditis, Echocardiography, Vegetations, Predictors, Outcome

Core Tip: Embolic events occur in up to 80% of patients with infective endocarditis (IE). Vegetations of > 10 mm in size are associated with increased embolic events and poor prognosis. In this retrospective cohort study, patients diagnosed with IE were recruited over 2 years. 34% of these had multiple vegetations. Echocardiographic features of moderate to severe regurgitation, presence of pacemaker lead, impaired left ventricle relaxation, and elevated pulmonary artery systolic pressure were associated with higher odds of multiple vegetation and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.