Distant embolisation in infective endocarditis: characteristics and outcomes

Abstract

Background: Infective endocarditis is a severe and potentially lethal cardiac disease. Recognition of the clinical features of endocarditis, such as distant embolisation, and adequate treatment should be initiated promptly given the grim perspective of upcoming virulent pathogens.

Methods: We report on our registry-based experience with outcomes of consecutive patients with infective endocarditis with distant embolisation. We aimed to describe the patient characteristics of infective endocarditis complicated by distant organ embolisation and the safety aspects of continuing endocarditis treatment at home in these patients.

Results: From November 2018 through April 2022, 157 consecutive patients were diagnosed with infective endocarditis. Of them, 38 patients (24%) experienced distant embolisation, either in the cerebrum (n = 18), a visceral organ (n = 5), the lungs (n = 7) or the myocardium (n = 8). Pathogens identified in blood cultures were predominantly streptococcal variants (43%), with only one culture-negative endocarditis case. Of the 18 patients with cerebral embolisation, 12 had neurological complaints and most often discrete abnormal findings on neurological examination. Six of the 8 cardiac embolism patients experienced chest pain before admission. Visceral organ and pulmonary embolism occurred silently. Of the 38 patients with distant embolisation, 17 could be discharged earlier by providing antibiotic treatment at home without complications.

Conclusion: This registry-based single-centre experience showed an incidence of distant embolisation in daily care of 24%. Cerebral and coronary embolisation provoked symptoms, while visceral emboli remained silent. Pulmonary emboli may present with inflammatory signs. Distant embolisation was not in itself a contra-indication for outpatient endocarditis@home treatment.

Keywords: Clinical cardiology; Embolisation; Imaging; Infective endocarditis.

Fig. 1

Total body maximum intensity projection with slices of fused ¹⁸F‑fluorodeoxyglucose positron emission tomography/computed tomography images showing embolisation to a right liver lobe, b biceps femoris muscle, c left mandibula (with possible primary (dental) focus) and d left ventricular apex. e Discrete focal FDG uptake is present in Jane Way lesion on medial side of right big toe

Fig. 2

Magnetic resonance imaging. a Section of cerebrum showing embolism in left internal capsule (see arrow). b Section of heart with transmural apical late enhancement with microvascular obstruction (see arrows) corresponding with recent transmural infarction