Relative value of clinical and transesophageal echocardiographic variables for risk stratification in patients with infective endocarditis

Abstract

SummaryRur.k,iy.~uiid: Infective endocarditis remains a life-threatening disease, and its optimal management is of paramount importance. Transesophageal echocardiography (TEE) is useful for the diagnosis of endocarditis-induced lesions, but the prognostic signi ticance of the method remains controversial.The purpose of this study was to relate clinical and TEE characteristics to the occurrence of mortality and/or systemic embolization in a consecutive series of 45 patients with a diagnosis of infective endocarditis. Methocls: All patients underwent at least one monoplane TEE. Clinical data, episodes ofembolization, and echocardiographic characteristics were prospectively recorded. Stepwise logistic discriminant analysis was performed to identiy the independent variables that best predicted three binary outcomes: systemic embolization, death, and systemic embolization and/ or death.Rcwlts: Twelve of the 45 patients (27%) died from the endocarditis. Significant univariate predictors of death were the presence of paravalvular abscess (p = 0.023, number of vegetations ( p = 0.02 I), Stuphylocor*cus uureus isolated in blood cultures (p = 0.002), medical treatment alone (p<0.002), and systemic embolism (p<O.OOl). In multivariate analysis, sys- Conclusions: High-risk patients may be identified by the combination of clinical variables and TEE characteristics.

Characteristics and Analysis of Risk Factors for Mortality in Infective Endocarditis

“…The emboli are one of the most common complications in endocarditis. The multivariate analysis has shown that mobile vegetation is an independent factor for emboli development [37][38][39] and mortality [40] in IE, which has also been shown by our study (data were not shown). No association was shown between the mortality and the prosthetic valve, type of valve involved and active microorganism.…”

“…However, many of the studies that investigated the effective factors on mortality are retrospective, and the results are conflicting. Some studies indicate that S.aureusinduced endocarditis is a risk factor for mortality [6,40], while some others demonstrate that it has no effect [22,43]. In a retrospective study, Chu et al [22] identified infection with S. aureus, diabetes mellitus, Apache II score and embolic events as independent risk factors for mortality; however, they didn't establish cardiac surgery and heart failure as independent risk factors.…”

“…The other independent risk factors for mortality are neurological abnormality [6,44], renal insufficiency [6,45], staphylococcal IE [6,18,24,40], bacterial etiology other than viridans streptococci except Staphylococcus aureus [22,43], non-cardiac shock [44], septic shock [46], older age ( ‡50 years) [44], cerebral emboli [46], systemic embolism [40], immunocompromised state [46], cardiac surgery [46] stroke [47], Nosocomial IE [2], prosthetic valve [2], comorbidity [43], abnormal mental status [43], medical therapy without valve surgery [40,43], and echocardiographic evidence of paravalvular abscess [40,48]. However, many of the studies that investigated the effective factors on mortality are retrospective, and the results are conflicting.…”

Infective endocarditis in elderly patients: clinical characteristics and outcome

“…The mobility of vegetation was graded on a scale of 1-4 with severe mobility corresponding to grade 4 [17]. Valvular regurgitation was quantified by Doppler echocardiography using the standard methods [14,17,18].…”

Early Predictors of In-Hospital Death in Infective Endocarditis

“…S aureus was the most common organism (44%) in this study, and the percentage of S aureus IE cases continues to increase. 9,20 This organism has been associated with both a higher rate of complications 11,21 and mortality in IE. 10,12,21,22 Earlier intervention before the development of complications may offer greater benefit for these patients.…”