Echocardiographic findings in patients with suspected infective endocarditis.
OBJECTIVE
To assess the echocardiographic findings in patients with suspected infective endocarditis.


METHODS
Two hundred sixty-two patients with suspected infective endocarditis underwent transthoracic and transesophageal echocardiographic investigation. Images of vegetations, valvular abscesses, and acute periprosthetic insufficiency were analyzed, and the correlation with clinical and laboratory data, diagnostic category, and hospital evolution was assessed.


RESULTS
The diagnosis of endocarditis was categorized as defined in 127 (47.8%) episodes, possible in 81 (30.4%), and rejected in 58 (21.8%). In patients with the defined diagnosis, the following images were identified: 135 vegetations, 37 abscesses, and 6 periprosthetic insufficiencies. Vegetations were more frequent in patients with endocarditis due to streptococci of the viridans group and enterococci (P=0.02), and with symptom duration < 10 days (P=0.001). Abscesses were more frequent in patients with symptom duration < 10 days (P=0.001). Periprosthetic insufficiency was associated with a greater need for surgical treatment (P=0.001). In patients with the possible diagnosis of endocarditis, 8 echocardiographic images considered compatible with vegetations were identified. In patients whose diagnosis of endocarditis was rejected, no vegetations, valvular abscesses, or periprosthetic insufficiencies were demonstrated.


CONCLUSIONS
Our echocardiographic findings varied according to the diagnostic category. The contribution to both the diagnosis and prognostic evaluation should consider the pretest probability of the diagnosis of infective endocarditis.
Vieira
Marcelo Luiz Campos
ML
Instituto do Coração, Hospital das Clínicas, FMUSP, São Paulo, Brazil. mlcvieira@aol.com
Grinberg
Max
M
Pomerantzeff
Pablo M A
PM
Andrade
José L de
JL
Mansur
Alfredo J
AJ
D000038:Abscess / Q000000981:diagnostic imaging* / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000382:microbiology; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000000981:diagnostic imaging*