Echocardiography in infective endocarditis: Reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach

Abstract

In 105 patients with active infective endocarditis, disease-associated complications defined as severe heart failure (New York Heart Association class IV), embolic events and in-hospital death were correlated to the vegetation size determined by both transthoracic and transesophageal echocardiography. A detailed comparison between anatomic and echocardiographic findings, performed in a subgroup of 80 patients undergoing surgery or necropsy, revealed that true valvular vegetations can be reliably identified by echocardiography in the vast majority of patients; the detection rate was significantly higher for the transesophageal (90%) than for the transthoracic (58%) approach, particularly when infected prosthetic valves were evaluated. However, an accurate echocardiographic differentiation between true vegetations and other endocarditis-induced valve destruction (ruptured leaflets or chordae) is impossible. The correlation of vegetation size with endocarditis-associated complications showed that patients with a vegetation diameter greater than 10 mm had a significantly higher incidence of embolic events than did those with a vegetation diameter less than or equal to 10 mm (22 of 47 versus 11 of 58; p less than 0.01). Particularly for patients with mitral valve endocarditis, a vegetation diameter greater than 10 mm was highly sensitive in identifying patients at risk for embolic events. Vegetation size, however, was not significantly different in patients with and without severe heart failure or in patients surviving or dying during acute endocarditis. In addition, no significant correlation was found between vegetation size and location of endocarditis or type of infective organism.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

“…[1][2][3][4] Complication rate in TEE is low, 5 but the procedure is semi-invasive, time consuming, and often not readily available everywhere. Therefore, it might be applied primarily to patients with stroke of undetermined etiology (ie, patients showing normal results in ECG, carotid ultrasound, and TTE, who are candidates for oral anticoagulation [OA]).…”

Infective Endocarditis and Acute Purulent Pericarditis in a Patient with Hyperglycemia

“…The highest incidence of embolic complication is observed in infective endocarditis due to hemolytic streptococcus C species as well as Staphyrococcus aureus, resulting in a high mortality rate (17)(18)(19)(20). It has been reported that size and mobility of the vegetation are highly sensitive in identifying patients at risk for embolic events (15). In the present patient, the size of the mobile vegetation became progressively enlarged over a few days despite maximal antimicrobial therapy.…”

“…Surgical therapy is recommended for patients with infective endocarditis who have congestive heart failure, perivalvular invasive disease, uncontrolled infection despite maximal antimicrobial therapy, or episodes of embolization with residual large vegetation (9,15,16). The highest incidence of embolic complication is observed in infective endocarditis due to hemolytic streptococcus C species as well as Staphyrococcus aureus, resulting in a high mortality rate (17)(18)(19)(20).…”

The long and short of vegetations in infective endocarditis

“…Vegetation length of greater than 15 mm was an independent predictor of 1-year mortality. It is unclear whether IE affecting a particular valve leads to a higher probability of embolization; mitral valve involvement has been suggested as conferring a higher embolic risk, especially with vegetations over 10 mm [12][13][14]16], while others have concluded that embolic risk is independent of vegetation location [10,11].…”

“…• Timing of echocardiography with respect to onset of patient symptoms and infrequent follow-up echocardiograms to assess vegetation status; [10][11][12][13][14], while others have not [15]. The latter study was performed before the era of TEE and vegetations were visualized by TTE in only 38% of patients [15].…”