title: Asymptomatic and symptomatic embolic events in infective endocarditis: associated factors and clinical impact.
abstract: BACKGROUND
  Embolic complications of infective endocarditis are common. The impact of asymptomatic embolism is uncertain.
  
  
  OBJECTIVE
  To determine the frequency of emboli due to IE and to identify events associated with embolism.
  
  
  METHODS
  Retrospective analysis of an endocarditis database, prospectively implemented, with a post hoc study driven by analysis of data on embolic events. Data was obtained from the International Collaboration Endocarditis case report forms and additional information on embolic events and imaging reports were obtained from the medical records. Variables associated with embolism were analyzed by the statistical software R version 3.1.0.
  
  
  RESULTS
  In the study period, 2006-2011, 136 episodes of definite infective endocarditis were included. The most common complication was heart failure (55.1%), followed by embolism (50%). Among the 100 medical records analyzed for emboli in left-sided infective endocarditis, 36 (36%) were found to have had asymptomatic events, 11 (11%) to the central nervous system and 28 (28%) to the spleen. Cardiac surgery was performed in 98/136 (72%). In the multivariate analysis, splenomegaly was the only associated factor for embolism to any site (p<0.01, OR 4.7, 95% CI 2.04-11). Factors associated with embolism to the spleen were positive blood cultures (p=0.05, OR 8.9, 95% CI 1.45-177) and splenomegaly (p<0.01, OR 9.28, 95% CI 3.32-29); those associated to the central nervous system were infective endocarditis of the mitral valve (p<0.05, OR 3.5, 95% CI 1.23-10) and male gender (p<0.05, OR 3.2, 95% CI 1.04-10). Splenectomy and cardiac surgery did not impact on in-hospital mortality.
  
  
  CONCLUSIONS
  Asymptomatic embolism to the central nervous system and to the spleen were frequent. Splenomegaly was consistently associated with embolic events.
authors.affiliation: Instituto Nacional de Cardiologia, Departamento de Doenças da Válvula Cardíaca, Rio de Janeiro, RJ, Brazil.
authors.forename: Thaíssa S
authors.initials: TS
authors.lastname: Monteiro
authors.affiliation: Instituto Nacional de Cardiologia, Departamento de Bioestatística, Rio de Janeiro, RJ, Brazil.
authors.forename: Marcelo G
authors.initials: MG
authors.lastname: Correia
authors.affiliation: Instituto Nacional de Cardiologia, Departamento de Doenças da Válvula Cardíaca, Rio de Janeiro, RJ, Brazil.
authors.forename: Wilma F
authors.initials: WF
authors.lastname: Golebiovski
authors.affiliation: Instituto Nacional de Cardiologia, Unidade de Controle de Infecções, Rio de Janeiro, RJ, Brazil.
authors.forename: Giovanna Ianini F
authors.initials: GIF
authors.lastname: Barbosa
authors.affiliation: Instituto Nacional de Cardiologia, Departamento de Doenças da Válvula Cardíaca, Rio de Janeiro, RJ, Brazil.
authors.forename: Clara
authors.initials: C
authors.lastname: Weksler
authors.affiliation: Instituto Nacional de Cardiologia, Departamento de Doenças da Válvula Cardíaca, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil; Universidade do Grande Rio (Unigranrio), Rio de Janeiro, RJ, Brazil. Electronic address: cristianelamas@gmail.com.
authors.forename: Cristiane C
authors.initials: CC
authors.lastname: Lamas
mesh_terms: D058070:Asymptomatic Diseases / Q000401:mortality; D004617:Embolism / Q000209:etiology* / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Asymptomatic embolism; Cardiac surgery; Embolism; Infective endocarditis; Splenectomy; Splenomegaly