Natural history of vegetations during successful medical treatment of endocarditis

Vuille, Cédric; Nidorf, Mark; Weyman, Arthur E.; Picard, Michael H.

doi:10.1016/0002-8703(94)90752-8

Cited by 74 publications

(29 citation statements)

References 16 publications

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“…Indeed there is no evidence on the best timing of echocardiography in literature. It is however known that presence and size of vegetations are relatively stable over time; 70% of vegetations were still present at the end of the antibiotic treatment period, and of these 59% did not show any difference in size [20]. Furthermore, the choice of antibiotic treatment appears to influence the size of vegetations on serial echocardiography; vancomycin-associated treatment was related to a 45% reduction of vegetation size, while penicillin reduced vegetation size only by 5% [21].…”

Section: Timing Of the Initial Echocardiographic Assessmentmentioning

confidence: 97%

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

2013

Cardiovasc Med

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SummaryBackground: The optimal timing of the initial echocardiographic assessment and the influence of microorganisms on echocardiographic findings in patients with infective endocarditis (IE) are not well studied.Methods: In 274 patients with IE, we studied the impact of antibiotic treatment duration of ≤2 days (early, 119 patients) or >2 days (late, 144 patients) prior to diagnostic echocardiography on IE specific findings and on clinical outcomes. Results were stratified for patients with Staphylococcus aureus (SA patients, n = 84) and those with other causative organisms (non-SA patients, n = 190).Results: There were no differences on specific echocardiographic findings between patients with early versus late echocardiography: Presence of vegetations: 91% vs 86%, p = 0.25; size of vegetations: 1.5 ± 0.7 cm vs 1.5 ± 0.8 cm, p = 0.83; paravalvular abscess: 24% vs 24%, p = 0.88, or valve destruction: 44% vs 35%, p = 0.17. There were also no differences in terms of clinical outcomes between the two groups: Heart surgery for IE in 61% vs 53%, p = 0.21, and in-hospital death in 8% vs 11%, p = 0.46. The presence of SA was not associated with specific findings on echocardiography or worse clinical outcomes compared to non-SA patients.Conclusions: In patients with infective endocarditis, the findings of early vs late initial echocardiographic a ssessment did not differ, and echocardiographic findings did not allow inference on the causing organism. Neither the timing of the initial echocardiographic study nor any organism involved was associated with clinical outcome.

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Section: Timing Of the Initial Echocardiographic Assessmentmentioning

confidence: 97%

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

2013

Cardiovasc Med

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“…Follow-up echocardiographic studies at the completion of therapy demonstrate persistent vegetations in 59% of cases; in the absence of severe valvular regurgitation or ongoing clinical symptoms, such persistence does not correlate with late complications. 35 In contrast, increase in vegetation size by echocardiography over the course of therapy may identify a subset of patients with a higher rate of complications, independently of the presence of persistent bacteremia or overt clinical stigmata of IE.…”

Section: Echocardiographymentioning

confidence: 99%

Diagnosis and Management of Infective Endocarditis and Its Complications

Bayer¹,

Bolger²,

Taubert³

et al. 1998

Circulation

642

407

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“…Most emboli occur early in the course of the illness, but an increase in the size of the vegetation while a patient is receiving effective treatment may be predictive of emboli. 150 The kidney and spleen may be involved during IE, with infarcts or abscesses related to emboli. The kidney may also be affected by glomerulonephritis secondary to immune complex depositions.…”

Section: 11mentioning

confidence: 99%