Analysis of Prognostic Factors in Infective Endocarditis by Transesophageal Echocardiography

Lee, Ki Man; Kang, Duk Hyun; Song, Jae Kwan; Kim, Chan; Lee, Sung Sun; Lee, Jae Won; Seo, Dong Man; Song, Meong Gun; Hong, Myeong Ki; Kim, Jae Jung; Park, Seong Wook; Park, Seung Jung

Abstract

BACKGROUND
In infective endocarditis, the recent introduction of transesophageal echocardiography(TEE) improved diagnostic sensitivity and detection of complications. Although the detection rate of vegetations is above 90% by TEE, the prognostic significance of these lesions remains unclear. The purpose of this study was to investigate prognostic factors for systemic embolism and death in infective emdocarditis by the analysis of transesophageal echocardiographic findings.
METHODS
Transthoracic echocardiography(TTE0 and TEE were performed in 56 patients with active left-sided infective endocarditis during admission. If a vegetation was present, the size, mobility and consistency of vegetation were analyzed and paravalvular complications were assessed by TEE. Systemic emboli and in-hospital death dude to infective endocarditis were correlated to clinical and echocardiographic findings.
RESULTS
1) Echocardiographic evaluation revealed vegetations(53 patients), abscess(13 patients) and left ventricular dysfunction(13 patients). Systemic embolic events occured in twenty patients(36%) and death occured in thirteen patients(23%). 2) The size, mobility or consistency of vegetation was all foung not to be significant predictor of systemic embolism. But the incidence of embolism is significantly higher in patients who revealed increased vegetation size on follow-up echocardiogram. 3) The incidence of death was significantly higher in patients with left ventricular dysfunction or abscess on echocardiography. Although the mobility or consistency of vegetation was not related to mortality, the mortality was higher significantly in patients with larger vegetations.
CONCLUSION
Our data suggest that left ventricular dysfunction, abscess and large vegetation are risk factors for higher mortality and increased vegetation size on follow-up echocardiography is risk factor for systemic embolism. Because TEE is more useful than TTE in evaluating of vegetation and paravalvular complications, TEE should be performed early in all patients with active left-sided infective endocarditis.