Mural Vegetation In Infective Endocarditis- Is It A Predictor For Embolism?

Abstract

Background: Infective endocarditis is a microbial infection of endocardial surface of the heart and vegetation is the characteristic lesion of the disease. Mural endocarditis is a condition of rare diagnosis and may be difficult to find vegetation by standard views in transthoracic echocardiography (TTE). Identifying the mural vegetation not only helps to diagnose Infective endocarditis, but also predicts the risk for developing embolism. Aim of this study is to find the occurrence of embolism in patients with mural endocarditis. Method: A Retrospective, observational study was done for IE patients admitted from the year 2012 to 2018, in which total of 58 patients with definite diagnosis of infective endocarditis were identified. Among which 8 patients were excluded based on the exclusion criteria. Results: Total 50 patients were identified with IE, which includes 7 with mural vegetation and 43 without mural vegetation. Cultures were positive in 71.4% and 88.3% IE patients with and without mural vegetation respectively. One patient was found to have corynebacterium species with mural vegetation and embolic stroke, which is a rare occurrence. Among 43 IE patients without mural vegetation, 88.3% patients showed presence of vegetation in echocardiogram. Size of vegetation were 13 ± 6 and 14.6 ± 2.9 mm, respectively (p>0.005). All the patients with mural vegetation and 9.3% from without mural vegetation had cerebral embolic events (p < 0.005). Conclusion: Though mural vegetation is not common, but if present, it helps in diagnosis and also it may predict a propensity for embolism. Our results indicate that in patients with mural endocarditis, the propensity of embolism is more.