Abstract Details

Title Patients with Right-sided Infective Endocarditis are at Risk for Neurological Complications even Without a Patent Foramen Ovale

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-002

Objective To determine whether the presence of a patent foramen ovale (PFO) is associated with neurologic complications among patients with right-sided infective endocarditis (RSIE) and whether RSIE confers neurologic risk in the absence of PFO.

Background Neurologic complications are frequent in infective endocarditis (IE) and include ischemic stroke, intracranial hemorrhage, brain abscess, and mycotic aneurysm. While most result from left-sided IE, systemic cerebral emboli may also occur in RSIE, traditionally attributed to paradoxical embolism through a PFO. Whether RSIE independently confers risk in patients without PFO remains unclear.

Design/Methods We performed a retrospective cohort study of consecutive adults hospitalized at Boston Medical Center with infective endocarditis (2013–2025). IE was classified by laterality (exclusively RSIE or not) and PFO status by TTE/TEE (± bubble) or TCD. The primary outcome was imaging-confirmed neurologic complications during index admission or within 45 days. We fit logistic models adjusted for age and sex to estimate odds ratios.

Results Among 346 patients with IE; 112 (32%) were RSIE of which 14 (12.5%) had PFO. Neurologic complications occurred in 22 (19.6%) of all patients with RSIE, 7 of 14 (50%) with PFO and 15 of 98 (15%) without PFO. In multivariable logistic regression, the presence of PFO was independently associated with nearly 8-fold higher odds of neurologic complications (7.98, 95% CI [1.92–33.23], p < 0.0001). Notably, a residual risk remained among RSIE patients without a PFO in whom approximately 1 in 6 developed a neurological complication.

Conclusions PFO greatly increases the risk of neurologic complications in RSIE, however RSIE carries a measurable risk even in the absence of a PFO. These findings suggest that paradoxical embolism is the commonest mechanism for neurologic complications in RSIE, however, they challenge the view that paradoxical embolism is required for cerebral involvement in RSIE and suggest that alternative mechanisms warrant investigation.

Authors/Disclosures
Ofelia Cespedes Moreno, MD PRESENTER	Dr. Cespedes Moreno has nothing to disclose.
Joseph Sisto (Boston Medical Center)	Joseph Sisto has nothing to disclose.
Matthew A. Kasper, BA	An immediate family member of Mr. Kasper has received personal compensation for serving as an employee of MedPro Group.
Robert Araujo Contreras (Boston Medical Center)	Mr. Araujo Contreras has nothing to disclose.
Steven K. Feske, MD (Boston Medical Center, Neurology Department)	Dr. Feske has received publishing royalties from a publication relating to health care.
Anna Marisa Cervantes-Arslanian, MD, FAAN (BU Dept of Neurology)	Dr. Cervantes-Arslanian has nothing to disclose.

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