title: Echocardiographic predictors of embolic events in infective endocarditis.
abstract: 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.
authors.affiliation: Cardiology Department, Institute for Cardiovascular Diseases C.C.Iliescu, Bucharest, Romania.
authors.forename: Cezar
authors.initials: C
authors.lastname: Macarie
authors.forename: Luminita
authors.initials: L
authors.lastname: Iliuta
authors.forename: Camelia
authors.initials: C
authors.lastname: Savulescu
authors.forename: Horatiu
authors.initials: H
authors.lastname: Moldovan
authors.forename: Dan Paul
authors.initials: DP
authors.lastname: Gherghiceanu
authors.forename: Rasvan
authors.initials: R
authors.lastname: Vasile
authors.forename: Daniela
authors.initials: D
authors.lastname: Filipescu
authors.forename: Vasile
authors.initials: V
authors.lastname: Candea
mesh_terms: 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