Echocardiographic predictors of embolic events in infective endocarditis.
BACKGROUND
Systemic embolisation occurs in 22% to 50% of patients with infective endocarditis (IE). Up to 65% of embolic events (EE) involve the central nervous system which increases the mortality rate. Several echocardiographic studies have demonstrated higher embolic rates with the increase of vegetation (VEG) dimensions and mobility.


OBJECTIVE
To define echocardiographic parameters which can help in identifying patients with a high risk of EE and to assess the value of transesophageal echocardiography (TEE) in predicting EE in patients with IE.


METHODS
236 patients (58% male, mean age 47.8+/-6) diagnosed with IE according to Duke criteria were followed for 3 years or until cardiac surgery. Echocardiographic parameters measured on VEG included the maximum length, thickness, the narrowest diameter, neck and mobility.


RESULTS
The rate of EE was 51.27% without any significant differences with respect to gender, age, fever, anaemia, VEG site or the presence of a significant regurgitation murmur. The univariate analysis showed a significant correlation between EE and IE caused by staphylococcus, IE of the right heart, and the length as well as mobility of VEG. The only independent predictors of EE were the maximum VEG length >15 mm and the increased mobility of VEG with a maximal displacement angle >60.7 degrees. In 23% of patients EE occurred after the initiation of antibiotic treatment. VEG in this group were big and very mobile (length >15 mm, maximal angle of displacement >65 degrees).


CONCLUSIONS
1. Vegetation dimension and mobility determined by TEE are important predictors of the embolic risk. 2. Significant echocardiographic predictors of embolic events included vegetation length >15 mm, neck/thickness ratio >0.69, and maximal angle of displacement of vegetation during cardiac cycle >60.7 degrees. 3. During antibiotic treatment, the embolic risk depends only on vegetation mobility and dimension.
Macarie
Cezar
C
Cardiology Department, Institute for Cardiovascular Diseases C.C.Iliescu, Bucharest, Romania.
Iliuta
Luminita
L
Savulescu
Camelia
C
Moldovan
Horatiu
H
Gherghiceanu
Dan Paul
DP
Vasile
Rasvan
R
Filipescu
Daniela
D
Candea
Vasile
V
D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000000981:diagnostic imaging