Vegetation size in patients with infective endocarditis

Leitman, Marina; Dreznik, Yael; Tyomkin, Vladimir; Fuchs, Therese; Krakover, Ricardo; Vered, Zvi

doi:10.1093/ejechocard/jer253

Cited by 44 publications

(46 citation statements)

References 22 publications

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“…Our finding that large vegetations were not independently associated with an increased risk of mortality agreed with those of Luaces and colleagues who found that vegetation size was not independently associated with an increased risk of death [6], but not with others who found that vegetation size was an independent predictor of mortality [5,7,8]. Possible reasons why our results were not concordant with others were differing study designs (retrospective, single center study [8] vs. larger, prospective, multi-center, and international), multiple pathogens [5,7,8] and different patient populations [5,8]. An example, which highlights the pathogen and native valve specific nature of our findings, is the study performed by Thuny and colleagues [5].…”

Section: Discussionsupporting

confidence: 90%

Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis

Lauridsen

Park

Tong

et al. 2015

Circ: Cardiovascular Imaging

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Background Staphylococcus (S.) aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S. aureus LNVIE is unknown. Methods and Results Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S. aureus IE were matched to those with S. aureus IE by the propensity of having S. aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S. aureus IE. One-year survival rates were significantly lower for patients with S. aureus IE overall (57% S. aureus IE vs. 80% non-S. aureus IE, p<0.001) and in the propensity-matched cohort (59% S. aureus IE vs. 68% non-S. aureus IE, p<0.05). Intracardiac abscess (HR 2.93; 95%CI 1.52–5.40, p<0.001) and left ventricular ejection fraction (LVEF)<40% (OR 3.01; 95%CI 1.35–6.04, p=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S. aureus LNVIE. Valve perforation (HR 2.16; 95% CI 1.21–3.68, p=0.006) and intracardiac abscess (HR 2.25; 95%CI 1.26–3.78, p=0.004) were the only independent predictors of one-year mortality. Conclusions S. aureus is an independent predictor of one-year mortality in subjects with LNVIE. In S. aureus LNVIE, intracardiac abscess and LVEF<40% independently predicted in-hospital mortality and intracardiac abscess and perforation independently predicted one-year mortality.

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Section: Discussionsupporting

confidence: 90%

Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis

Lauridsen

Park

Tong

et al. 2015

Circ: Cardiovascular Imaging

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“…Vegetation size: patients with vegetation length >10 mm are at higher risk of embolism,[3] and this risk is even higher in patients with very large (>15 mm) and mobile vegetations;[4]Vegetation mobility: from fixed to prolapsing;[5]Vegetation consistency: calcified lesions do not have embolic potentiality; those with a consistency equal or inferior to that of myocardial echoes are associated with increased risk of embolic complications;[6]Vegetation extent: involvement of a single valve leaflet (particularly the location on the mitral valve) or multiple valve leaflets, the extension to extravalvular structures;[7]The increasing or decreasing size of the vegetation under antibiotic therapy;[8]Particular microorganisms (Staphylococci[9], Streptococcus bovis [10], Candida spp. );…”

Section: Discussionmentioning

confidence: 99%

“…Vegetation size: patients with vegetation length >10 mm are at higher risk of embolism,[3] and this risk is even higher in patients with very large (>15 mm) and mobile vegetations;[4]…”

Section: Discussionmentioning

confidence: 99%

Is there a role for tissue doppler imaging in infective endocarditis?

Sonaglioni

Rigamonti

Trotta

et al. 2014

J Cardiovasc Echography

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An 87-year-old woman was admitted to our Cardiology Department with symptoms and signs of acute congestive heart failure and fever. She had a long history of hypertension and chronic atrial fibrillation. Transthoracic echocardiography showed a large (>10 mm) and mobile mitral valve vegetation, prolapsing into the left ventricular inflow tract, with severe mitral regurgitation due to a perforation in the posterior leaflet, in a mitral valve with fibro-calcific degeneration. Mitral regurgitation was hemodynamically significant and a moderate-to-severe pulmonary hypertension was observed. Tissue Doppler Imaging recorded at the level of the vegetation detected its incoherent motion and measured the peak antegrade velocity, which was found to be almost four times higher than that sampled at the lateral mitral annulus. Blood cultures were negative for both aerobic and anaerobic microbes. During hospitalization, the patient developed a sudden onset of left-side hemiplegia. Diffusion-weighted magnetic resonance imaging demonstrated multiple hyperintense lesions involving both hemispheres, suggestive of a cardioembolism. Diagnosis of fungal endocarditis was made and a treatment with fluconazole was started. Successive echocardiograms showed a decrease in the size and mobility of the mitral vegetation, and an increase in its echo intensity. However, in view of the systemic conditions severely affected, the patient was treated conservatively and died 3 months later. In our patient echocardiography played a key role for a better definition of the clinical course. In this context, Tissue Doppler Imaging might provide an adjunctive parameter for the prediction of embolic risk from endocardial vegetations: the peak antegrade velocity recorded at the level of the vegetation. However, before being adopted in clinical setting, this parameter should be validated by adequately powered prospective studies.

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“…Owing to the organism involved and the size/location of the vegetation in our patient, the chance of papillary muscle and/or chordal rupture leading to acute mitral regurgitation was considered to be high 8–13. It was for this reason that the multidisciplinary team agreed that early surgical repair or replacement of the mitral valve apparatus must be considered, as ample evidence indicates improved clinical outcomes in patients with such complicated infections 14 15. The ultimate decision to treat our patient with a prolonged course of antibiotic therapy was based on his high operative risk profile given his liver disease, current haemodynamic and valve stability, early speciation of a virulent but susceptible organism, and the desire of the patient to avoid valve replacement surgery.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment, despite a non-surgical approach, of severe infective endocarditis

Boulos

Jeong

2013

BMJ Case Reports

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A 60-year-old man with a history of Child-Pugh class B cirrhosis was admitted to the hospital with 4-5 days of nausea, vomiting and altered mental status. Following the development of fever in the intensive care unit and methicillin-sensitive Staphylococcus aureus bacteraemia, a large (15 mm) vegetation was discovered on the anterolateral papillary muscle of the mitral valve. Following a thorough multidisciplinary evaluation, the patient was considered to be a poor surgical candidate due to the significant perioperative complications associated with Child-Pugh class B cirrhosis. The patient was treated with 6 weeks intravenous nafcillin as an outpatient. Echocardiography following the treatment course revealed that the vegetation had completely resolved without any valvular dysfunction. This case report emphasises that medical management remains an effective alternative to surgery in complicated cases of infective endocarditis.

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Vegetation size in patients with infective endocarditis

Cited by 44 publications

References 22 publications

Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis

Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis

Is there a role for tissue doppler imaging in infective endocarditis?

Successful treatment, despite a non-surgical approach, of severe infective endocarditis

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