Right sided infective endocarditis features and complications : Retrospective analytical study / Fouad Fawzy Fouad Bekhit ; Supervised Wael Mohamed Elnaggar , Sameh Wadeee Bakhoum , Marwa Said Meshaal

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiology

Purpose: to describe the current incidence, epidemiologic, clinical, microbiological, echocardiographic and prognostic features of right-sided IE (RSIE) in comparison to left-sided IE (LSIE), to compare between the intravenous drug abuser (IVDA) group and the non-intravenous drug abuser group within the RSIE patients and to determine in-hospital predictors of embolic events and mortality in patients with RSIE. {u2028} Methods: Retrospective analytic study that included 313 patients with a definite or possible IE in the period between February 2005 and February 2015. Results: 72 (23%) patients had RSIE. The whole group was relatively young with median age of 30 years (range: 3-65) in the RSIE group and 31 years (range: 6-75) in left-sided IE group. Male gender was more prevalent in the RSIE group [70.8%vs 55.6%, p =0.021]. The right sided IE group had a higher incidence of IVDA [43.1%vs 1.2%, p<0.001]. Congenital heart diseases were more prevalent in the RSIE group [12.5%vs 7.5%, p<0.001]. Chronic renal failure on regular dialysis was more common in the RSIE group [11.1%vs 3.6%, p<0.001]. The RSIE group had more peripheral [20.8%vs.10.8%, p=0.027] and central venous catheterization than the LSIE group [9.7% vs. 0.4%, p<0.001]. Fever and respiratory symptoms due to septic pulmonary emboli were more common in the RSIE group when compared to the LSIE group [86.1%vs 65.6%, p=0.001]. The presence of needle puncture marks was significantly more common in the RSIE group [19.4% vs. 0.4%, p<0.001]. Hemoglobin level was significantly lower in the RSIE group [8.5g/dl vs 9.4 g/dl, p<0.001] with higher mean values of white blood cells [16.7cmvs 12.8cm, p=0.001], baseline creatinine [1.95mg/dlvs 1.24 mg/dl, p=0.001] and C {u2013}reactive protein [120vs 90.5, p=0.005] in the RSIE group. Microscopic hematuria was statistically more positive in the RSIE group [27.8%vs 17.8%, p=0.05]. Echocardiography detected vegetations in all patients in the RSIE group versus 93.7% of patients in the LSIE group (p =0.062). The tricuspid valve was the most commonly involved in 63 (87.5%) patients, while pulmonic valve infection occurred in 7 cases. Vegetations larger than 10mm in diameter were more common in the RSIE group (80.5%vs 54.7%, p = 0.002). Blood cultures were more positive in the RSIE group (69.4%vs 46.5%, p<0.001).

Issued also as CD