INCIDENCE AND PROGNOSIS OF EMBOLIC EVENTS AND METASTATIC INFECTIONS IN INFECTIVE ENDOCARDITIS

Aims In infective endocarditis, the true incidence of embolic events a nd metastatic infections remains unknown probably because a large numb er of events are asymptomatic. The consequences of the prognosis of su ch events have never been evaluated by a prospective follow-up. This s tudy aimed to assess the incidence of symptomatic or asymptomatic embo lic events and metastatic infections in definite infective endocarditi s and to determine whether these events carry a risk of mortality. Met hods and results From January 1991 to December 1993, 102 patients with suspected or known infective endocarditis were referred to our instit ution. Among them, we selected 68 patients (50 males, LS females, mean age=52.7 years) exhibiting definite infective endocarditis according to the Duke University criteria. Blood cultures were positive in 49 ca ses (72%). Echocardiography revealed valvular vegetations in 55 cases (81%). Irrespective of the clinical presentation, patients were examin ed radiologically by cerebral computed tomography scanning (n=60), mag netic resonance imaging (n=3), abdominal computed tomography scanning (n=32) or abdominal echocardiography (n=20). Depending on the symptoms , thoracic computed tomography scanning (n=22), pulmonary angiography (n=2), ventilation-perfusion scintigraphy (n=4), or gallium citrate ra dionuclide scanning (n=7) were also performed. All patients were prosp ectively followed-up for a mean period of 21.4 +/- 17.5 months. In 35 patients (51%), 51 embolic or metastatic events were revealed, involvi ng the central nervous system (n=23), spleen (n=7), kidney (n=5), lung (n=5), liver (n=4), bone and joint (n=4), iliac (n=2) or mesenteric ( n=1) arteries. During the hospital stay, the mortality rate was higher in patients exhibiting embolic or metastatic events (20 vs 12%), but the difference did not reach statistical significance. Kaplan-Meier an alysis demonstrated no difference in long-term follow-up. Conclusion O ur data suggest that embolic or metastatic events had a high incidence (51%) during infective endocarditis, but were not associated with sig nificant attributable mortality.