Key result
Mitral valve involvement is linked to ~30-fold higher PE risk alongside Staphylococcus infection.
Why the study?
Pulmonary embolism complicating left-sided infective endocarditis is extremely rare, and the absence of predisposing factors or typical symptoms often leads to misdiagnosis and delayed treatment.
Case Report (n=76)
Effect estimate: OR 29.728 (95% CI 4.026-219.528)
p-value: p=0.001
Contrast echocardiography of the right heart is valuable for diagnosing culture-negative infective endocarditis, while mitral valve involvement and Staphylococcus infection are independent risk factors for pulmonary embolism in these patients.
Mitral valve involvement or Staphylococcus infection warrants PE vigilance in left-sided IE; extends risk stratification beyond right-sided predominance.
Background Infective endocarditis (IE) is a life-threatening infection of the endocardial surface. Pulmonary embolism (PE) as a complication of left-sided IE is extremely rare, while right-sided IE—accounting for only 5-10% of all IE cases—is relatively associated with PE. The absence of predisposing factors or typical symptoms (e.g., fever, cardiac murmur) often leads to misdiagnosis and delayed treatment. This study reports a rare case of left-sided IE complicated by PE, combined with a literature review to provide diagnostic and prognostic insights. Case Presentation A 49-year-old male with no comorbidities presented with acute lumbar and abdominal pain, without typical IE manifestations. Blood cultures were negative, and routine echocardiography appeared normal. However, contrast echocardiography of the right heart revealed echogenic masses on the anterior and posterior mitral valve leaflets (7.6 × 5.6 mm and 7.3 × 5.2 mm), crucial for diagnosis. The patient also developed cerebral, splenic, and bilateral renal infarctions, and lower limb deep venous thrombosis. Despite treatment with piperacillin (4.5 g q8h) and heparin calcium, he died.For literature review, six databases (PubMed, CNKI, CBM, Wanfang, VIP, Yiigle) were searched for studies (2020-2024) using “infective endocarditis [Title] AND embolism”. Seventy-five eligible cases of IE with embolism in adults (18-65 years) were analyzed to evaluate IE-PE correlation. Conclusions Contrast echocardiography of the right heart is valuable for confirming IE when routine echocardiography is normal. Advanced tools such as metagenomic next-generation sequencing (mNGS) and PCR assist in pathogen detection in culture-negative cases. Statistical analysis of 75 cases identified mitral valve involvement (OR = 29.728, 95%CI: 4.026-219.528, P = 0.001) and Staphylococcus infection (OR = 4.461, 95%CI: 1.023-19.454, P = 0.047) as independent risk factors for PE. Empirical anti-Staphylococcal therapy, multidisciplinary surgical evaluation, and early management of major complications (e.g., cerebral infarction, heart failure) are essential to improve prognosis. This abstract is funded by: No
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Zhao et al. (2026) conducted a case report in Infective endocarditis with embolism (n=76). Contrast echocardiography of the right heart was evaluated on Independent risk factors for pulmonary embolism (mitral valve involvement) (OR 29.728, 95% CI 4.026-219.528, p=0.001). In an analysis of 75 cases, mitral valve involvement (OR 29.728; 95% CI 4.026-219.528; P=0.001) and Staphylococcus infection (OR 4.461; P=0.047) were independent risk factors for pulmonary embolism.
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