This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mathew, J. Articles by Freels, S. Search for Related Content PubMed PubMed Citation Articles by Mathew, J. Articles by Freels, S. Pubmed/NCBI databases Medline Plus Health Information Heart Failure Social Bookmarking                   What's this?

Value of Echocardiographic Findings in Predicting Cardiovascular Complications in Infective Endocarditis

Iowa City, IA and Galesburg and Chicago, IL

Aswini Anand, MD

Iowa City, IA and Galesburg and Chicago, IL

Theodore Addai, MD

Iowa City, IA and Galesburg and Chicago, IL

Sally Freels, PhD

Iowa City, IA and Galesburg and Chicago, IL

Echocardiography allows the detection of vegetations and estimation of valvular dysfunction in patients with infective endocarditis. The value of echocardiographic findings in predicting cardiac and other vascular complications in infective endocarditis is not well understood. Identification of high-risk patients and early surgery may improve their prognosis. The authors reviewed echocardiographic findings and related them to the development of congestive heart failure, systemic embolism, and the need for surgery or the risk of death without surgery in patients with infective endocarditis.

There were 125 episodes of endocarditis in 114 patients (84 episodes [67%] in men) with a mean age ± standard deviation of 37 ±7 years. Vegetations were detected by echocardiog raphy on at least 1 valve in 87 episodes (70%); on the mitral valve in 36 episodes (29%); on the aortic valve in 21 episodes (17%); and on the tricuspid valve in 45 episodes (36%). Severe aortic regurgitation was present in 9 episodes (7%) and severe mitral regurgitation in 4 instances (3%). In 12 of 21 episodes (57%) of vegetations on the aortic valve compared with 15 of 104 patients (14%) without vegetations on the aortic valve (p < 0.00 1), and in 8 of 9 instances (89%) of severe aortic regurgitation compared with 19 of 116 episodes (16%) without severe aortic regurgitation (p < 0.00001), the patients developed congestive heart failure. In 18 of 55 episodes (33%) of vegetations on the aortic/mitral valve compared with 17 of 70 episodes (25%) without vegetations on the aortic valve/mitral valve (p=NS), the patients developed systemic embolism. In 13 of 21 episodes (62%) of vegetations on the aortic valve compared with 19 of 104 episodes (19%) without vegetations on the aortic valve (p < 0.001 ), and in 8 of 9 episodes (89%) of severe aortic regurgitation compared with 24 of 116 episodes (21%) without severe aortic regurgitation (p < 0.00001), the patients either had surgery or died without surgery.

Echocardiographic findings do not reliably predict the risk of systemic embolism in patients with infective endocarditis. Vegetations on the aortic valve and severe aortic regurgitation detected by echocardiography predict a high risk of developing congestive heart failure, and for the combined outcome of requiring surgery, or dying without surgery in infective endocarditis. Early surgery may improve the outlook for survival of these patients.

Angiology, Vol. 52, No. 12, 801-809 (2001)
DOI: 10.1177/000331970105201201


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?