2026/07/31 by Małgorzata Misztal-Ogonowska, Maciej Grabowski, Karina Zatorska +5
Medicine · #Actinomycetales infections and treatment #Confidence interval #Embolism #Endocarditis #Infectious Aortic and Vascular Conditions #Infective Endocarditis Diagnosis and Management #Infective endocarditis #Odds ratio #Retrospective cohort study #Sepsis
paper · pdf · doi:10.33963/v.phj.113976
crossref issued 2026/07/31 · crossref published 2026/07/31 · crossref published-online 2026/07/31 · openalex publication_date 2026/07/31 · crossref created 2026/07/31 · crossref deposited 2026/07/31 · crossref indexed 2026/07/31 · openalex created_date 2026/08/01 · openalex updated_date 2026/08/02
BACKGROUND: Septic embolism, heart failure, perivalvular involvement, and uncontrolled infection are common complications of infective endocarditis (IE) and frequent indications for surgery. AIMS: We evaluated the impact of introducing whole‑body computed tomography (WB‑CT; brain, chest, abdomen) into the diagnostic work-up of patients with left‑sided IE (LS-IE) on detection of embolic and perivalvular complications and on surgical indications. METHODS: We retrospectively analyzed 366 patients admitted with LS-IE from 2015 to 2024. Patients were classified according to whether WB-CT was performed during hospitalization. RESULTS: Of 366 patients, 132 (36.1%) underwent WB‑CT. Mean age was 57.9 (15.7) years, 79.8% were men, and surgery was performed in 268 patients (73.2%). Among patients who underwent WB-CT, embolic complications occurred in the spleen in 56 (42.4%), the brain in 28 (21.2%), and other sites in 23 (17.4%). The WB-CT strategy detected extracardiac embolic complications more often than the non-WB-CT protocol at each site (P <0.001). Perivalvular pseudoaneurysms were identified more frequently on CT than on echocardiography (P = 0.008). Among operated patients with WB‑CT (n = 94; 35.1%), embolism prevention was the main indication (47.9% vs. 23.0%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.80-5.26; P <0.001). By contrast, heart failure predominated in the non-WB-CT group (47.1% vs. 19.1%; OR, 0.26; 95% CI, 0.15-0.48; P <0.001). CONCLUSIONS: WB-CT was associated with a higher detection of embolic and perivalvular complications in LS-IE and with a different pattern of surgical indications, with embolism prevention more frequent in the WB-CT group.