Clinical Characteristics, Echocardiographic Feature, and Predictor of Embolic Events in Infective Endocarditis
AbstractBackground. There are many risk factors that are associated with embolic events in patients with Infective Endocarditis (IE) ranging from infecting organism, valve location, vegetation morphology, to age. Nevertheless, echocardiography role in predicting embolic events in patients with Infective Endocarditis remains controversial. Some studies reported an increased risk of embolism in patients with large and mobile vegetations, whereas other studies failed to demonstrate such a relationship.
Objectives. The aim of this study is to assess the risk factors that are associated with embolic events and to evaluate the role of transthoracic echocardiography (TTE) in predicting embolic events (EEs) in a small group of patients with definite endocarditis according to the Duke criteria.
Methods. Subjects more than 17 years of age, who were enrolled in National Cardiac Center Harapan Kita Infective Endocarditis Registry and who had complete TTE recording were selected for this study. Fourteenpatients with definite Infective Endocarditis according to the Duke Criteria who were hospitalised within 2010 – 2011 were examined with M-mode and two-dimension echocardiogram. The incidence of embolism was compared with the clinical and echocardiographic characteristics (localization and mobility) of the vegetations.
Results. Among 14 patients, 5 (35,7%) had one or more EEs. There were no difference between patients with and without embolism in terms of infecting organism, gender and vegetation mobility. Five out of 9 patients (55%) with mitral valve involvement vegetation had EE. No patients with only aortic and tricuspid valve vegetations had EEs. And all of the patents with EE had mitral valve involvement. Thus, there was a significant higher incidence of embolism was present in patients with mitral valve involvement of vegetation (100%, p = 0,038).
Conclusion. Our study shows that the involvement of mitral valve on TTE is predictive of embolism.
De Castro S, Magni G, Beni S, Cartoni D, Fiorelli M, Venditti M, et al. Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves. Am J Cardiol. 1997 Oct 15;80(8):1030-4.
Sanfilippo AJ, Picard MH, Newell JB, Rosas E, Davidoff R, Thomas JD, et al. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol. 1991 Nov 1;18(5):1191-9.
Rohmann S, Erbel R, Gorge G, Makowski T, Mohr-Kahaly S, Nixdorff U, et al. Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. Eur Heart J. 1992 Apr;13(4):446-52.
Lutas EM, Roberts RB, Devereux RB, Prieto LM. Relation between the presence of echocardiographic vegetations and the complication rate in infective endocarditis. Am Heart J. 1986 Jul;112(1):107-13.
Habib G. [Infective endocarditis: what’s new? European Society of Cardiology (ESC) Guidelines 2009 on the prevention, diagnosis and treatment of infective endocarditis]. Presse Med. 2010 Jun;39(6):704-9.
Habib G. Management of Infective Endocarditis. The Heart Journal. 2006:7.
Harrison JL, Prendergast BD, Habib G. The European society of cardiology 2009 guidelines on the prevention, diagnosis, and treatment of infective endocarditis: key messages for clinical practice. Pol Arch Med Wewn. 2009 Dec;119(12):773-6.
Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200-9.
Fournier PE, Casalta JP, Habib G, Messana T, Raoult D. Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis. Am J Med. 1996 Jun;100(6):629-33.
Plicht B, Erbel R. [Diagnosis and treatment of infective endocarditis. Current ESC guidelines]. Herz. 2010 Dec;35(8): 542-8.
Gilbert Habib LB, Christopher Tribouilloy, Isidre Vilacosta, and Jose Luis Zamorano. Recommendations for the practice of echocardiography in infective endocarditis. European Journal of Echocardiography. 2010(11):202-19.
Habib G. Guidelines on the prevention, diagnosis and treatment of infective endocarditis (new version 2009). European Heart Journal. 2009;30:7.
Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010 Mar;11(2):202-19.
Daniel WG, Mugge A, Martin RP, Lindert O, Hausmann D, Nonnast-Daniel B, et al. Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med. 1991 Mar 21;324(12):795-800.
Di Salvo G, Habib G, Pergola V, Avierinos JF, Philip E, Casalta JP, et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol. 2001 Mar 15;37(4):1069-76.
Baddour LM, Wilson WR, Bayer AS, Fowler VG, Jr., Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005 Jun 14;111(23):e394-434.
Mugge A, Daniel WG, Frank G, Lichtlen PR. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol. 1989 Sep;14(3):631-8.
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