INFECTIVE ENDOCARDITIS - CLINICAL AND ECHOCARDIOGRAPHIC FEATURES IN THE 1980S

The clinical and echocardiographic characteristics of patients with in fective endocarditis hospitalized at a large medical center between Ja nuary 1984 and December 1988 were evaluated. Included were 30 patients with a definite diagnosis of infective endocarditis, all of whom unde rwent at least one echocardiographic examination during their hospital course. Clinical characteristics of the endocarditis group included: presence of previous valvular heart disease (80%), fever (100%), splen omegaly (43%), petechiae (20%), embolic phenomena (23%), and prehospit alization disease duration of a 12-day period. Streptococcus viridans was the most frequent causative pathogen (36.6%); however, 10 patients (33%) had staphylococci isolated from their blood cultures. Rheumatic heart disease was the most common underlying valvular disease (50%). However, congenital heart disease (20%) and ischemic heart disease (13 %) were also common. Three patients (10%) had surgery and subsequently recovered (valve replacement-1; vegetectomy-1; and vegetectomy plus c orrection of partial atrioventricular canal malformation-1). Two patie nts (16.7%) died during hospitalization. The echocardiographic feature s in these patients and those of 30 randomly selected age-matched pati ents with valvular heart disease, who served as controls, were blindly evaluated by two observers. Echocardiographic results were graded in 5 groups according to the probability of having vegetations. Echocardi ographic images were graded as positive for the presence of vegetation s in 17/30 (56.6%) of the echocarditis patients and in only 1 of the c ontrol group (p < 0.001). Diagnosis was especially difficult in patien ts with prosthetic valves and in those with heavily calcified valves.W e conclude that the clinical picture of endocarditis is indeed changin g. Conventional echocardiography is a useful noninvasive tool for the detection of vegetations in native valves. Transesophageal echocardiog raphy (TEE) is recommended for patients with prosthetic or heavily cal cified valves.