Infective endocarditis with single or multivalvular involvement: clinical, microbiological characteristics and outcomes in a tertiary care center

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%, p