Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study.
BACKGROUND
The incidence of embolic events (EE) and death is still high in patients with infective endocarditis (IE), and data about predictors of these 2 major complications are conflicting. Moreover, the exact role of echocardiography in risk stratification is not well defined.


RESULTS
In a multicenter prospective European study, including 384 consecutive patients (aged 57+/-17 years) with definite IE according to Duke University criteria, we tested clinical, microbiological, and echocardiographic data as potential predictors of EE and 1-year mortality. Transesophageal echocardiography was performed in all patients. Embolism occurred before or after IE diagnosis (total-EE) in 131 patients (34.1%) and after initiation of antibiotic therapy (new-EE) in 28 patients (7.3%). Staphylococcus aureus and Streptococcus bovis were independently associated with total-EE, whereas vegetation length >10 mm and severe vegetation mobility were predictors of new-EE, even after adjustment for S aureus and S bovis. One-year mortality was 20.6%. In multivariable analysis, independently of the other predictors of death (age, female sex, creatinine serum >2 mg/L, moderate or severe congestive heart failure, and S aureus) and comorbidity, vegetation length >15 mm was a predictor of 1-year mortality (adjusted relative risk=1.8; 95% CI, 1.10 to 2.82; P=0.02).


CONCLUSIONS
In IE, vegetation length is a strong predictor of new-EE and mortality. In combination with clinical and microbiological findings, echocardiography may identify high-risk patients who will need a more aggressive therapeutic strategy.
Department of Cardiology, La Timone Hospital, Marseille, France.
Franck
F
Thuny
Giovanni
G
Di Salvo
Giovanni
G
Disalvo
Olivier
O
Belliard
Jean-François
JF
Avierinos
Valeria
V
Pergola
Valerie
V
Rosenberg
Jean-Paul
JP
Casalta
Joanny
J
Gouvernet
Geneviève
G
Derumeaux
Diana
D
Iarussi
Pierre
P
Ambrosi
Raffaele
R
Calabró
Raffaello
R
Calabro
Alberto
A
Riberi
Frédéric
F
Collart
Dominique
D
Metras
Hubert
H
Lepidi
Didier
D
Raoult
Jean-Robert
JR
Harle
Pierre-Jean
PJ
Weiller
Ariel
A
Cohen
Gilbert
G
Habib
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002423:Cause of Death; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D013210:Staphylococcus / Q000302:isolation & purification; D016019:Survival Analysis
D000900:Anti-Bacterial Agents