Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study

Circulation. 2005 Jul 5;112(1):69-75. doi: 10.1161/CIRCULATIONAHA.104.493155. Epub 2005 Jun 27.

Abstract

Background: The incidence of embolic events (EE) and death is still high in patients with infective endocarditis (IE), and data about predictors of these 2 major complications are conflicting. Moreover, the exact role of echocardiography in risk stratification is not well defined.

Methods and results: In a multicenter prospective European study, including 384 consecutive patients (aged 57+/-17 years) with definite IE according to Duke University criteria, we tested clinical, microbiological, and echocardiographic data as potential predictors of EE and 1-year mortality. Transesophageal echocardiography was performed in all patients. Embolism occurred before or after IE diagnosis (total-EE) in 131 patients (34.1%) and after initiation of antibiotic therapy (new-EE) in 28 patients (7.3%). Staphylococcus aureus and Streptococcus bovis were independently associated with total-EE, whereas vegetation length >10 mm and severe vegetation mobility were predictors of new-EE, even after adjustment for S aureus and S bovis. One-year mortality was 20.6%. In multivariable analysis, independently of the other predictors of death (age, female sex, creatinine serum >2 mg/L, moderate or severe congestive heart failure, and S aureus) and comorbidity, vegetation length >15 mm was a predictor of 1-year mortality (adjusted relative risk=1.8; 95% CI, 1.10 to 2.82; P=0.02).

Conclusions: In IE, vegetation length is a strong predictor of new-EE and mortality. In combination with clinical and microbiological findings, echocardiography may identify high-risk patients who will need a more aggressive therapeutic strategy.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Cause of Death
  • Echocardiography, Transesophageal*
  • Embolism / etiology*
  • Endocarditis, Bacterial / complications
  • Endocarditis, Bacterial / diagnosis*
  • Endocarditis, Bacterial / mortality
  • Endocarditis, Bacterial / therapy
  • Humans
  • Incidence
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk
  • Staphylococcus / isolation & purification
  • Survival Analysis

Substances

  • Anti-Bacterial Agents