Echocardiographic assessment of patients with infectious endocarditis: Prediction of risk for complications
Open accessAbstract
To enhance the echocardiographic identification of high risk lesions in patients with infectious endocarditis, the medical records and two-dimensional echocardiograms of 204 patients with this condition were analyzed. The occurrence of specific clinical complications was recorded and vegetations were assessed with respect to predetermined morphologic characteristics. The overall complication rates were roughly equivalent for patients with mitral (53%), aortic (62%), tricuspid (77%) and prosthetic valve (61%) vegetations, as well as for those with nonspecific valvular changes but no discrete vegetations (57%), although the distribution of specific complications varied considerably among these groups. There were significantly fewer complications in patients without discernible valvular abnormalities (27%). In native left-sided valve endocarditis, vegetation size, extent, mobility and consistency were all found to be significant univariate predictors of complications. In multivariate analysis, vegetation size, extent and mobility emerged as optimal predictors and an echocardiographic score based on these factors predicted the occurrence of complications with 70% sensitivity and 92% specificity in mitral valve endocarditis and with 76% sensitivity and 62% specificity in aortic valve endocarditis.
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Several studies with transthoracic echocardiography have demonstrated a trend toward higher embolic rates with left-sided vegetations greater than 1 cm in diameter.
“Several studies with TTE have demonstrated a trend toward higher embolic rates with left-sided vegetations >1 cm in diameter.55”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [55]
In Echocardiographic Findings (page unavailable), the paper says vegetation size helps identify patients with native left-sided valve endocarditis at risk of complications, and it includes embolization among the complications assessed. The passages do not establish a higher embolic rate specifically for vegetations greater than 1 cm. (LLM, conf=0.79)
Experimental — accuracy not yet measuredSystemic embolization occurs in 22% to 50% of cases of infective endocarditis.
“Systemic embolization occurs in 22% to 50% of cases of IE. 55,57,[274][275][276][277]”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [55]
The paper’s clinical-event definitions include systemic embolization, but the passages available from our copy do not give its frequency. Searches for the 22%–50% range and for embolization rates in the Results and Table 2 did not locate a supporting figure. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Sanfilippo, A. J., Picard, M. H., Newell, J. B., Rosas, E., Davidoff, R., Thomas, J. D., & Weyman, A. E.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- Corresponding author
- Sanfilippo, Anthony J.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1991-11
- Volume
- 18
- Issue
- 5
- Pages
- 1191-1199
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2091438055
- Semantic Scholar
- 77cbe2ef81fa55b216750cf99958a15b75b73716
- Cited by
- 328
- References
- 23
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 8 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 9 · 2015: 12 · 2014: 9 · 2013: 13 · 2012: 9
- FWCI
- 4.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5t32hl007535-08)
- National Heart, Lung, and Blood Institute (HL-07535)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- infective endocarditis, echocardiographic assessment, vegetation characteristics, complication prediction, vegetation size, mitral valve endocarditis, aortic valve endocarditis, tricuspid valve endocarditis, prosthetic valve endocarditis, risk stratification
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Aortic Valve, Echocardiography, Endocarditis, Bacterial, Female, Heart Valve Prosthesis, Humans, Male, Middle Aged, Mitral Valve, Predictive Value of Tests, Regression Analysis, Sensitivity and Specificity, Survival Rate
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