Vol 60, No 6 (2004)
Other
Published online: 2005-12-12
Submitted: 2012-12-28
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Echocardiographic predictors of embolic events in infective endocarditis

Cezar Macarie, Luminita Iliuta, Camelia Savulescu, Horatiu Moldovan, Dan Gherghiceanu, Rasvan Vasile, Daniela Filipescu, Vasile Candea
Kardiol Pol 2004;60(6):540-540.
Vol 60, No 6 (2004)
Other
Published online: 2005-12-12
Submitted: 2012-12-28

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.
Aim: 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 >60.7o. 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 >65o).
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 >60.7o. 3. During antibiotic treatment, the embolic risk depends only on vegetation mobility and dimension.

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.
Aim: 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 >60.7o. 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 >65o).
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 >60.7o. 3. During antibiotic treatment, the embolic risk depends only on vegetation mobility and dimension.
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Keywords

infective endocarditis - transesophageal echocardiography - embolic events - echocardiography - vegetation

About this article
Title

Echocardiographic predictors of embolic events in infective endocarditis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 60, No 6 (2004)

Pages

540-540

Published online

2005-12-12

Bibliographic record

Kardiol Pol 2004;60(6):540-540.

Keywords

infective endocarditis - transesophageal echocardiography - embolic events - echocardiography - vegetation

Authors

Cezar Macarie
Luminita Iliuta
Camelia Savulescu
Horatiu Moldovan
Dan Gherghiceanu
Rasvan Vasile
Daniela Filipescu
Vasile Candea

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