Complications and outcome of infective endocarditis
- Denis Spelman, MBBS, FRACP, FRCPA, MPH
Denis Spelman, MBBS, FRACP, FRCPA, MPH
- Adjunct Professor, Monash University
- Alfred Hospital, Victoria, Australia
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Gabriel S Aldea, MD
Gabriel S Aldea, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Ann Bolger, MD, FACC, FAHA
Ann Bolger, MD, FACC, FAHA
- Section Editor — Valvular and Aortic Disease
- Professor of Medicine
- University of California, San Francisco
Infective endocarditis (IE) is associated with a broad array of complications. The likelihood of complication(s) depends on several factors including the infecting pathogen, duration of illness prior to therapy, and underlying comorbidities . Complications can occur before, during, and after completion of therapy.
It can be difficult to assess the true incidence of complications since case series are frequently retrospective. In one review including 223 episodes of IE, 57 percent of patients had one complication, 26 percent had two, 8 percent had three or more, and 6 percent had six or more complications .
Issues related to complications and outcome of IE will be reviewed here. Indications for surgery and timing of surgery in patients with complications of IE are discussed further separately. (See "Surgery for left-sided native valve infective endocarditis" and "Surgery for prosthetic valve endocarditis".)
Other issues related to IE are discussed separately. (See related topics.)
COMPLICATIONS OF ENDOCARDITIS
Complications of infective endocarditis (IE) include cardiac, neurologic, renal, musculoskeletal, and pulmonary complications as well as complications related to systemic infection (including embolization, metastatic infection, and mycotic aneurysm). More than one complication can occur simultaneously.
- Hoen B, Duval X. Infective endocarditis. N Engl J Med 2013; 369:785.
- Mansur AJ, Grinberg M, da Luz PL, Bellotti G. The complications of infective endocarditis. A reappraisal in the 1980s. Arch Intern Med 1992; 152:2428.
- Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293:3012.
- Millaire A, Van Belle E, de Groote P, et al. Obstruction of the left main coronary ostium due to an aortic vegetation: survival after early surgery. Clin Infect Dis 1996; 22:192.
- Molavi A. Endocarditis: recognition, management, and prophylaxis. Cardiovasc Clin 1993; 23:139.
- Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation 1976; 54:140.
- Omari B, Shapiro S, Ginzton L, et al. Predictive risk factors for periannular extension of native valve endocarditis. Clinical and echocardiographic analyses. Chest 1989; 96:1273.
- Daniel WG, Mügge A, Martin RP, et al. Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med 1991; 324:795.
- Attias D, Messika-Zeitoun D, Wolf M, et al. Acute coronary syndrome in aortic infective endocarditis. Eur J Echocardiogr 2008; 9:727.
- Cosmi JE, Tunick PA, Kronzon I. Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr 2004; 17:766.
- Bayer AS. Infective endocarditis. Clin Infect Dis 1993; 17:313.
- Kahveci G, Bayrak F, Pala S, Mutlu B. Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves. Tex Heart Inst J 2009; 36:111.
- Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435.
- Rose RL Jr, Higgins LS, Helgason AH. Bacterial endocarditis, pericarditis and cardiac tamponade. Am J Cardiol 1967; 19:447.
- Alió-Bosch J, Tornos-Mas MP, Soler-Soler J. Cardiac tamponade as an initial clinical presentation of infective endocarditis. Int J Cardiol 1987; 14:373.
- Parashara DK, Jacobs LE, Kotler MN, et al. Angina caused by systolic compression of the left coronary artery as a result of pseudoaneurysm of the mitral-aortic intervalvular fibrosa. Am Heart J 1995; 129:417.
- Abad C. Acute infectious mitroaortic endocarditis in association with acute aortic dissection. Surgical management of an unusual combination of diseases. Cardiovasc Surg 1995; 3:605.
- Anguera I, Miro JM, Vilacosta I, et al. Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality. Eur Heart J 2005; 26:288.
- Steckelberg JM, Murphy JG, Ballard D, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991; 114:635.
- De Castro S, Magni G, Beni S, et al. Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves. Am J Cardiol 1997; 80:1030.
- Snygg-Martin U, Gustafsson L, Rosengren L, et al. Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers. Clin Infect Dis 2008; 47:23.
- Jones HR Jr, Siekert RG. Neurological manifestations of infective endocarditis. Review of clinical and therapeutic challenges. Brain 1989; 112 ( Pt 5):1295.
- Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis. Medicine (Baltimore) 1978; 57:329.
- Mohr JP, Caplan LR, Melski JW, et al. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology 1978; 28:754.
- Di Salvo G, Habib G, Pergola V, et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001; 37:1069.
- Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation 1998; 98:2936.
- Rohmann S, Erbel R, Görge G, et al. Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. Eur Heart J 1992; 13:446.
- Fowler VG Jr, Sanders LL, Kong LK, et al. Infective endocarditis due to Staphylococcus aureus: 59 prospectively identified cases with follow-up. Clin Infect Dis 1999; 28:106.
- Sanfilippo AJ, Picard MH, Newell JB, et al. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol 1991; 18:1191.
- Kupferwasser LI, Hafner G, Mohr-Kahaly S, et al. The presence of infection-related antiphospholipid antibodies in infective endocarditis determines a major risk factor for embolic events. J Am Coll Cardiol 1999; 33:1365.
- Thuny F, Di Salvo G, Belliard O, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005; 112:69.
- Hubert S, Thuny F, Resseguier N, et al. Prediction of symptomatic embolism in infective endocarditis: construction and validation of a risk calculator in a multicenter cohort. J Am Coll Cardiol 2013; 62:1384.
- Ellis ME, Al-Abdely H, Sandridge A, et al. Fungal endocarditis: evidence in the world literature, 1965-1995. Clin Infect Dis 2001; 32:50.
- Fabri J Jr, Issa VS, Pomerantzeff PM, et al. Time-related distribution, risk factors and prognostic influence of embolism in patients with left-sided infective endocarditis. Int J Cardiol 2006; 110:334.
- Dickerman SA, Abrutyn E, Barsic B, et al. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). Am Heart J 2007; 154:1086.
- Weinstein L. Life-threatening complications of infective endocarditis and their management. Arch Intern Med 1986; 146:953.
- Robinson SL, Saxe JM, Lucas CE, et al. Splenic abscess associated with endocarditis. Surgery 1992; 112:781.
- Schlesinger LS, Ross SC, Schaberg DR. Staphylococcus aureus meningitis: a broad-based epidemiologic study. Medicine (Baltimore) 1987; 66:148.
- Bisdas T, Teebken OE. Mycotic or infected aneurysm? Time to change the term. Eur J Vasc Endovasc Surg 2011; 41:570; author reply 570.
- Garvey GJ, Neu HC. Infective endocarditis--an evolving disease. A review of endocarditis at the Columbia-Presbyterian Medical Center, 1968-1973. Medicine (Baltimore) 1978; 57:105.
- Harrison MJ, Hampton JR. Neurological presentation of bacterial endocarditis. Br Med J 1967; 2:148.
- Røder BL, Wandall DA, Espersen F, et al. Neurologic manifestations in Staphylococcus aureus endocarditis: a review of 260 bacteremic cases in nondrug addicts. Am J Med 1997; 102:379.
- Parrino PE, Kron IL, Ross SD, et al. Does a focal neurologic deficit contraindicate operation in a patient with endocarditis? Ann Thorac Surg 1999; 67:59.
- Ruttmann E, Willeit J, Ulmer H, et al. Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke 2006; 37:2094.
- García-Cabrera E, Fernández-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation 2013; 127:2272.
- Cooper HA, Thompson EC, Laureno R, et al. Subclinical brain embolization in left-sided infective endocarditis: results from the evaluation by MRI of the brains of patients with left-sided intracardiac solid masses (EMBOLISM) pilot study. Circulation 2009; 120:585.
- Klein I, Iung B, Labreuche J, et al. Cerebral microbleeds are frequent in infective endocarditis: a case-control study. Stroke 2009; 40:3461.
- Duval X, Iung B, Klein I, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med 2010; 152:497.
- Merkler AE, Chu SY, Lerario MP, et al. Temporal relationship between infective endocarditis and stroke. Neurology 2015; 85:512.
- Grabowski M, Hryniewiecki T, Janas J, Stępińska J. Clinically overt and silent cerebral embolism in the course of infective endocarditis. J Neurol 2011; 258:1133.
- Anderson DJ, Goldstein LB, Wilkinson WE, et al. Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis. Neurology 2003; 61:1341.
- Conlon PJ, Jefferies F, Krigman HR, et al. Predictors of prognosis and risk of acute renal failure in bacterial endocarditis. Clin Nephrol 1998; 49:96.
- Speechly-Dick ME, Swanton RH. Osteomyelitis and infective endocarditis. Postgrad Med J 1994; 70:885.
- Roth GA, Dwyer-Lindgren L, Bertozzi-Villa A, et al. Trends and Patterns of Geographic Variation in Cardiovascular Mortality Among US Counties, 1980-2014. JAMA 2017; 317:1976.
- Wallace SM, Walton BI, Kharbanda RK, et al. Mortality from infective endocarditis: clinical predictors of outcome. Heart 2002; 88:53.
- Chu VH, Cabell CH, Benjamin DK Jr, et al. Early predictors of in-hospital death in infective endocarditis. Circulation 2004; 109:1745.
- Hasbun R, Vikram HR, Barakat LA, et al. Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA 2003; 289:1933.
- Hill EE, Herijgers P, Claus P, et al. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J 2007; 28:196.
- Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 2007; 297:1354.
- Cabell CH, Pond KK, Peterson GE, et al. The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J 2001; 142:75.
- Lauridsen TK, Park L, Tong SY, et al. Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study. Circ Cardiovasc Imaging 2015; 8:e003397.
- López J, Fernández-Hidalgo N, Revilla A, et al. Internal and external validation of a model to predict adverse outcomes in patients with left-sided infective endocarditis. Heart 2011; 97:1138.
- COMPLICATIONS OF ENDOCARDITIS
- Cardiac complications
- - Heart failure
- - Perivalvular abscess
- - Other cardiac complications
- Metastatic infection
- - Septic embolization
- Risk factors
- Effect of antibiotic therapy
- - Metastatic abscess
- - Mycotic aneurysm
- Neurologic complications
- Renal complications
- Musculoskeletal complications
- Pulmonary complications
- Complications related to therapy
- INFORMATION FOR PATIENTS