Echocardiography predicts embolic events in infective endocarditis

OBJECTIVES The aim of our study was to assess the value of transesophageal echocardiography (TEE) in predicting embolic events (EEs) in a large group of patients with definite endocarditis according tu the Duke criteria, incl uding silent embolism. BACKGROUND The value of echocardiography in predicting embolism in patients with endocarditis remains controversial. Some studies reported an increase d risk of embolism in patients with large and mobile vegetations, whereas o ther studies failed to demonstrate such a relationship. METHODS Multiplane transesophageal echocardiograms of 178 consecutive patie nts with definite infective endocarditis (IE) were analyzed. The incidence of embolism was compared with the echocardiographic characteristics (locali zation, size and mobility) of the vegetations. To detect silent embolism, c erebral and thoraco-abdominal scans were performed in 95% of patients. RESULTS Among 178 patients, 66 (37%) had one or more EEs. There was no diff erence between patients with and without embolism in terms of age, gender a nd left valve involved. On univariate analysis, Staphylococcus infection, r ight-side valve endocarditis and vegetation length and mobility were signif icantly related tu EEs. A significant higher incidence of embolism was pres ent in patients with vegetation length >10 mm (60%, p < 0.001) and in patie nts with mobile vegetations (62%, p < 0.001). Embolism was particularly fre quent among 30 patients with both severely mobile and large vegetations (>1 5 mm) (83%, p < 0.001). On multivariate analysis, the only predictors of em bolism were vegetation length (p = 0.03) and mobility (p = 0.01). CONCLUSIONS Our study shows that the presence of vegetations on TEE is pred ictive of embolism and that the morphologic characteristics of vegetations are helpful in predicting EEs in both mitral and aortic Valve IE. it also s uggests that early operation may be recommended in patients with Vegetation s >15 mm and high mobility, irrespective of the degree of valve destruction , heart failure and response to antibiotic therapy. (J Am Coll Cardiol 2001 ;37:1069-76) (C) 2001 by the American College of Cardiology.