Echocardiographic assessment of patients with infectious endocarditis: Prediction of risk for complications

Abstract

To enhance the echocardiographic identification of high risk lesions in patients with infectious endocarditis, the medical records and two-dimensional echocardiograms of 204 patients with this condition were analyzed. The occurrence of specific clinical complications was recorded and vegetations were assessed with respect to predetermined morphologic characteristics. The overall complication rates were roughly equivalent for patients with mitral (53%), aortic (62%), tricuspid (77%) and prosthetic valve (61%) vegetations, as well as for those with nonspecific valvular changes but no discrete vegetations (57%), although the distribution of specific complications varied considerably among these groups. There were significantly fewer complications in patients without discernible valvular abnormalities (27%). In native left-sided valve endocarditis, vegetation size, extent, mobility and consistency were all found to be significant univariate predictors of complications. In multivariate analysis, vegetation size, extent and mobility emerged as optimal predictors and an echocardiographic score based on these factors predicted the occurrence of complications with 70% sensitivity and 92% specificity in mitral valve endocarditis and with 76% sensitivity and 62% specificity in aortic valve endocarditis.

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2)

“…En EI por Pseudomona aeuriginosa, Enterobacteriaceas y hongos, esta mortalidad puede superar el 50% de los casos durante el período intrahospitalario. En una reciente comunicación del grupo del Estudio Colaborativo Internacional de EI (ICE-PCS), la mortalidad durante el episodio agudo fue de 17,7% 5 , a pesar de los avances crecientes en infectología, los altos estándares en aplicación para la técnica de los hemocultivos (automatización), los nuevos y poderosos antibióticos que se emplean en la actualidad en esta enfermedad [6][7][8][9][10] , de la incorporación de nuevas técnicas diagnósticas imagenológicas, entre las que se destaca, especialmente la ecocardiografía [11][12][13][14][15][16][17][18][19] ; los nuevos y estrictos criterios diagnósticos que se han incorporado [20][21][22] y el perfeccionamiento de las técnicas cardioquirúrgicas, incluidos rigurosos controles pre e intraoperatorios, así como de los dispositivos intracardiacos en uso [23][24][25][26][27] , todos ellos factores que se suman para reducir la morbimortalidad de esta patología en las últimas décadas [28][29][30] , esta mortalidad continúa elevada.…”

Infective endocarditis complicated with cerebral and splenic infarction in a hemodialysis patient

“…The highest embolic rates (regardless of size) have been seen in mitral vegetations (25%), especially those that are attached to the anterior mitral leaflet. [13]…”

Achados ecocardiográficos em pacientes com suspeita diagnóstica de endocardite infecciosa

“…Up to 65% of the embolic events may affect the central nervous system 2 , with a lower frequency in the different organs and places 23,24 . Previous studies [24][25][26][27][28][29][30] about the frequency of embolic phenomena in regard to the dimensions and mobility of vegetations are considered controversial. Some studies [24][25][26][27] report a greater frequency of embolic phenomena in patients with vegetations with dimensions > 10 mm, with great mobility, and with involvement of the mitral valve 26 .…”

“…Previous studies [24][25][26][27][28][29][30] about the frequency of embolic phenomena in regard to the dimensions and mobility of vegetations are considered controversial. Some studies [24][25][26][27] report a greater frequency of embolic phenomena in patients with vegetations with dimensions > 10 mm, with great mobility, and with involvement of the mitral valve 26 . Other series do not report a greater frequency of embolic phenomena in patients with vegetations > 10 mm [28][29][30] and with great mobility 28,30 .…”

“…The different series diverge in regard to the results and the echocardiographic methods used for identifying the vegetations. Some series used only the transthoracic investigation 25,27,29 , while others the transesophageal 24,26,28,30 .…”