Evaluation of Systemic Embolism in Patients with Prosthetic Valve Endocarditis: Key Insights and Implications

OBJECTIVE
Prosthetic valve endocarditis (PVE) is a severe complication following heart valve surgery, presenting significant diagnostic and therapeutic challenges. Despite advances in treatment, systemic embolism remains a critical complication associated with poor outcomes. We aimed to identify predictors of in-hospital systemic embolism in patients with PVE and evaluate treatment outcomes.

METHODS
This retrospective, single-center study included 96 patients with mechanical PVE admitted between 2012 and 2024. Diagnoses were confirmed using the modified Duke criteria. Data on demographics, comorbidities, clinical features, imaging, and treatment strategies were analyzed. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were used to identify risk factors.

RESULTS
The study cohort had a median age of 52.4 years (range 22–82). Systemic embolic events occurred in 39 patients (40.6%), with stroke being the most common (26%). Multivariate analysis identified vegetation size as the sole independent predictor of systemic embolism (odds ratio [OR]: 2.34, p=0.037). ROC analysis showed a vegetation size threshold of 2 cm², with 66% sensitivity and 78% specificity. Elevated erythrocyte sedimentation rate (ESR) and prior stroke history were also associated with higher embolism risk. Among 31 surgical patients, early surgery did not significantly reduce embolism rates compared to delayed surgery. Treatment success was protective against embolism (p=0.045).

CONCLUSIONS
Larger vegetations, elevated ESR, and prior stroke history are key risk factors for systemic embolism in PVE. Early identification and individualized management strategies are essential to improve outcomes. Further multicenter research is warranted to refine treatment protocols.