ENDOCARDITIS-ASSOCIATED PARAVALVULAR ABSCESSES - DO CLINICAL-PARAMETERS PREDICT THE PRESENCE OF ABSCESS

Study objective: To determine whether standard clinical and transthora cic echocardiographic criteria considered to be suggestive of the pres ence of endocarditis-associated paravalvular abscess are predictive of which patients would benefit from reliable but invasive transesophage al echocardiographic investigations for abscess. Design: Retrospective chart review. Setting: A 630-bed university hospital. Patients: Forty -eight patients with 51 episodes of definite endocarditis and 24 parav alvular abscesses. Measurements and results: A comparison of abscess a nd nonabscess populations revealed that clinical parameters (patient d emographics, valvular involvement, presence of a prosthesis, infection with a virulent organism, pericarditis, persistent fever, persistent bacteremia, congestive heart failure, history of intravenous drug use, embolization) and transthoracic echocardiographic parameters were ins ensitive predictors of the presence of abscess. The only statistically significant correlate was the presence of previously undetected atrio ventricular or bundle branch block. Paravalvular abscesses were common in our population and were associated with increased mortality. Impro ved survival correlated with the absence of mitral valve involvement a nd the absence of moderate-to-severe congestive heart failure. Conclus ions: Given the accuracy and safety of transesophageal echocardiograph y and the unreliability of clinical and transthoracic echocardiographi c criteria, we recommend that transesophageal echocardiography be cons idered in all endocarditis patients with previously unrecognized condu ction disturbances, aortic or prosthetic valve involvement, or both, o r indications for valve replacement, or all of the foregoing.