INFECTIVE ENDOCARDITIS, 1983-1988 - ECHOCARDIOGRAPHIC FINDINGS AND FACTORS INFLUENCING MORBIDITY AND MORTALITY

The echocardiograms and clinical records of 70 patients with infective endocarditis seen between 1983 and 1988 were examined to evaluate the role of two-dimensional and Doppler echocardiography in the diagnosis of infective endocarditis and identify risk factors for morbidity and mortality. A blinded observer reviewed the echocardiograms for the presence and size of vegetations and the severity of the valvular regurgitation. Vegetations were identified in 54 (78%) of 69 technically satisfactory echocardiograms. In 38 patients whose heart was examined at surgery or autopsy, all vegetations diagnosed by echocardiography were confirmed, but six additional vegetations were found. Abnormal (≥2+) valvular regurgitation was present in 88% of patients. No patient with ≤1+ regurgitation (n = 8) died or required valve surgery for heart failure, but three of the eight patients did undergo surgery for mycotic aneurysm, recurrent embolism or paravalvular abscess. In patients without embolism before echocardiography, there was a trend toward a greater incidence of subsequent embolism in those with vegetations >10 mm in size (26% [8 of 31] compared with 11% [2 of 18] with vegetations ≤10 mm) (p = 0.19). By multivariate analysis, risk factors for in-hospital death (n = 7) were an infected prosthetic valve (p < 0.007), systemic embolism (p < 0.02) and infection with Staphylococcus aureus (p = 0.05). It is concluded that 1) if valvular regurgitation is ≤1+, the risk of in-hospital death is low, and progression to cardiac surgery for hemodynamic instability is unlikely; 2) there is a trend toward a higher risk of embolization in patients with vegetations >10 mm in size; 3) early mortality now relates to infected prosthetic heart valves, embolism and Staphylococcus aureus; and 4) when a paravalvular abscess or prosthetic valve endocarditis is suspected, transthoracic echocardiographic findings are often equivocal and transesophageal echocardiography may be of benefit. © 1990, American College of Cardiology Foundation. All rights reserved.