Multivalvular infective endocarditis was associated with numerically higher, though not statistically significant, mortality compared to single-valve involvement (27.6% vs 13.4%, p=0.082).
Observational (n=114)
No
Does multivalvular involvement compared to single-valve involvement worsen clinical outcomes and mortality in patients with infective endocarditis?
Multivalvular infective endocarditis is associated with more severe clinical presentation and structural damage, including a significantly higher rate of abscess formation, compared to single-valve involvement.
Absolute Event Rate: 27.6% vs 13.4%
p-value: p=0.082
Abstract Introduction Infective endocarditis (IE) with multivalvular involvement (MVIE) is a rare and serious entity associated with higher mortality and complications compared with single-valve involvement (SVIE). Despite its clinical relevance, it has not been extensively studied. Purpose To describe and compare the clinical, echocardiographic and microbiological characteristics of patients with MVIE versus SVEI and to analyse their in-hospital outcomes. Materials and Methods This is a single-centre prospective registry including patients with definite IE according to the modified Duke criteria from April 2021 to February 2025. Demographic data, clinical presentation, IE characteristics (native vs. prosthetic valve, early vs. late presentation, single vs. multivalvular involvement) were collected. Transthoracic (TTE) and transoesophageal (TOE) echocardiographic parameters were systematically recorded. In addition, computed tomography (CT) data on intracardiac complications and peripheral embolism were analysed. Microbiological data, indications for surgery, reasons for conservative management, and in-hospital outcomes, including mortality, were also assessed. Results 114 patients with a definite diagnosis of IE were included, most of whom were male (71,1%) with a mean age of 70years. Among the enrolled patients 33 (28.9%) presented with MVIE. Compared to SVEI, MVIE patients presented with a higher NYHA class (III–IV: 41.3% vs. 21.7%, p=0.048), a greater incidence of atrioventricular block (17.5% vs. 3.5%, p=0.025), and a more frequent involvement of the mitral valve. Echocardiographic findings showed that MVIE patients had a significantly higher rate of abscess formation (50% vs. 11.4%, p0.001), confirmed by computed tomography (CT) assessment. Blood cultures were positive in 79 cases (69.3% of the total), with no significant difference between the groups (65.5% vs 70.6%, p=0.609). Staphylococcus aureus remained the predominant pathogen. Most of the patients underwent surgery in both groups (65.5% in MVIE vs. 72.6% in SVEI, p=0.468). Mortality and in-hospital mortality were numerically higher in MVIE (respectively 27.6% vs 13.4%, p=0.082 and 13.8% vs. 4.9%, p=0.111), and mortality was higher in patients who did not undergo surgery (40% in MVIE vs. 21.7% in SVEI, p=0.279). Univariate and multivariate analyses identified the presence of an abscess or pseudoaneurysm on CT and baseline NYHA class as independent predictors of mortality (respectively OR 6.429, 95% CI 1.790–23.083, p=0.004 and OR 2.75, 95% CI 1.62–4.64, p=0.001). Conclusions MVIE is associated with a more severe clinical presentation, greater structural valvular damage, and worse in-hospital outcomes compared to SVEI. Early recognition through comprehensive imaging and microbiological assessment is crucial for timely intervention. Given the significant impact on prognosis, a tailored therapeutic approach may be essential to improving patient outcomes.Table Uni/Multivariate analysis for mortality
Balata et al. (2026) conducted an observational in Infective endocarditis (n=114). Multivalvular involvement vs. Single-valve involvement was evaluated on Mortality (p=0.082). Multivalvular infective endocarditis was associated with numerically higher, though not statistically significant, mortality compared to single-valve involvement (27.6% vs 13.4%, p=0.082).