As compared with conventional treatment, early surgery in patients with infective endocarditis and large vegetations significantly reduced the composite end point of death from any cause and embolic events by effectively decreasing the risk of systemic embolism. (EASE ClinicalTrials.gov number, NCT00750373.).

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Cardiac CT can accurately demonstrate infective endocarditis in pre-operative patients with a similar diagnostic accuracy to TEE. The interobserver agreements for the CT findings of infective endocarditis were excellent.

Background-Surgical indications to prevent systemic embolism in infective endocarditis (IE)

Seo JS, Kim DH, Kim WJ, Song JM, Kang DH, Song JK. Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility. Am J Physiol Heart Circ Physiol 298: H1608 -H1615, 2010. First published March 5, 2010; doi:10.1152/ajpheart.01231.2009.-We sought to test whether the peak systolic velocity of mitral annular longitudinal movement (S=) measured by pulsed tissue Doppler imaging technique is useful to assess global left ventricular (LV) contractility under various LV inotropic conditions, including regional wall motion abnormality. In addition, the accuracy of S= relative to LV ejection fraction (EF), a conventional index of LV contractility, and its association with apical rotation, a new index of LV contractility, were also evaluated. We measured S= at the medial mitral annulus and apical rotation in 11 open-chest anesthetized dogs at eight inotropic stages before and after ligation of either the left anterior descending or circumflex coronary artery. Maximal positive dP/dt (dP/dt peak) was monitored using a high-fidelity pressure catheter and used as the standard measure of LV contractility. S= showed dose-dependent increases and decreases after dobutamine and esmolol infusion, respectively. There was a stronger association between dP/dt peak and S= (R 2 ϭ 0.665, P Ͻ 0.001) than between dP/dtpeak and EF (R 2 ϭ 0.408, P Ͻ 0.001), and this trend was more apparent with coronary ligation, regardless of the ligation site. The strength of association between dP/dt peak and S= (R 2 ϭ 0.665) was not different from that between dP/dt peak and apical rotation (R 2 ϭ 0.726) (P ϭ 0.350). The association between LV EF and S= was modest (R 2 ϭ 0.472, P Ͻ 0.001), whereas a good association between S= and apical rotation was observed both with (R 2 ϭ 0.552, P Ͻ 0.001) and without (R 2 ϭ 0.674, P Ͻ 0.001) coronary ligation. S= is a more sensitive index of global LV contractility than is LV EF, reflecting both LV longitudinal shortening and torsional deformation. contractility; echocardiography; longitudinal movement; ventricular rotation DESPITE EARLY RECOGNITION of abundant longitudinal cardiac muscle fibers (31), the function of these longitudinal fibers could not be extensively investigated before successful clinical introduction of echocardiography. Initial M-mode recording of mitral annular descent or excursion reflecting left ventricular (LV) longitudinal shortening during ejection was reported to be a sensitive measure of LV systolic function, and the amplitude of long-axis motion during systole also correlates well with LV ejection fraction (EF) (12,23,28). Later, the development of tissue Doppler imaging (TDI) provided an easier way to measure peak systolic velocity of mitral annular longitudinal movement (S=), with S= found useful in diagnosing global LV systolic dysfunction in many cardiac diseases (2,4,8,16,20,27). Moreover, the prognostic implication of S= has been documented in patients with heart failure, mitral regurgitati...