Multivalvular vs single-valve infective endocarditis: a systematic review and meta-analysis.

BACKGROUND

Infective endocarditis is characterized by the colonization of heart valves by virulent microorganisms. It commonly manifests as involvement of a single heart valve -single-valve infective endocarditis (SIE), while in some patients, two or more heart valves are concomitantly infected -multivalvular infective endocarditis (MIE). The risk of complications and prognosis of MIE as opposed to SIE are unknown.

METHODS

We performed a systematic search in MEDLINE and Scopus for studies of patients with MIE and SIE. The outcomes of interest included mortality, heart failure, systemic embolic events, and need for surgery.

RESULTS

Οf 1,124 identified studies, eleven met the inclusion criteria. MIE was reported in 20.4% of the total patients. Compared to SIE, MIE was associated with increased risk of short-term mortality (RR: 1.29, 95% CI: 1.19-1.39), one-year mortality (RR: 1.20, 95% CI: 1.08-1.34), heart failure (RR: 1.31, 95% CI: 1.12-1.54), systemic embolic events (RR: 1.12, 95% CI: 1.02-1.22), and need for subsequent surgical management (RR: 1.22, 95% CI: 1.05-1.41).

CONCLUSIONS

Patients with MIE have a higher likelihood of poor prognosis compared to patients with SIE. A high clinical suspicion of this condition and timely diagnosis and management are imperative while managing patients with infective endocarditis.

PROTOCOL REGISTRATION: PROSPERO CRD42023486674.