Article (Scientific journals)
Relative value of clinical and transesophageal echocardiographic variables for risk stratification in patients with infective endocarditis.
Lancellotti, Patrizio; Galiuto, Leonarda; Albert, Adelin et al.
1998In Clinical Cardiology: International Journal for Cardiovascular Diseases, 21 (8), p. 572-8
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Keywords :
Discriminant Analysis; Echocardiography, Transesophageal; Embolism/epidemiology; Endocarditis, Bacterial/mortality/ultrasonography; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Risk Assessment
Abstract :
[en] BACKGROUND: Infective endocarditis remains a life-threatening disease, and its optimal management is of paramount importance. Transesophageal echocardiography (TEE) is useful for the diagnosis of endocarditis-induced lesions, but the prognostic significance of the method remains controversial. HYPOTHESIS: The purpose of this study was to relate clinical and TEE characteristics to the occurrence of mortality and/or systemic embolization in a consecutive series of 45 patients with a diagnosis of infective endocarditis. METHODS: All patients underwent at least one monoplane TEE. Clinical data, episodes of embolization, and echocardiographic characteristics were prospectively recorded. Stepwise logistic discriminant analysis was performed to identify the independent variables that best predicted three binary outcomes: systemic embolization, death, and systemic embolization and/or death. RESULTS: Twelve of the 45 patients (27%) died from the endocarditis. Significant univariate predictors of death were the presence of paravalvular abscess (p = 0.025), number of vegetations (p = 0.021), Staphylococcus aureus isolated in blood cultures (p = 0.002), medical treatment alone (p < 0.002), and systemic embolism (p < 0.001). In multivariate analysis, systemic embolism (chi 2 = 29.3; p < 0.01), echocardiographic evidence of paravalvular abscess (chi 2 = 5.6; p = 0.018), Staphylococcus aureus endocarditis (chi 2 = 5.5; p = 0.016), and medical treatment alone (chi 2 = 5.11; p = 0.024) emerged as optimal predictors of death. Systemic embolization occurred in 12 patients. Independent variables predicting systemic embolization were a total length of vegetations > 14 mm (p = 0.01), greater age (p = 0.02), and medical treatment alone (p = 0.03). When two or more vegetations were observed, the total length is the sum of the individual sizes. Independent risk factors for the development of systemic emboli and/or death as a combined end point were total length of vegetations on TEE (chi 2 = 6.4; p = 0.003) and medical treatment alone (chi 2 = 4.1; p = 0.047). CONCLUSIONS: High-risk patients may be identified by the combination of clinical variables and TEE characteristics.
Disciplines :
General & internal medicine
Author, co-author :
Lancellotti, Patrizio  ;  Université de Liège - ULiège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie
Galiuto, Leonarda
Albert, Adelin  ;  Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
SOYEUR, Daniel ;  Centre Hospitalier Universitaire de Liège - CHU > Cardiologie
Pierard, Luc ;  Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Language :
English
Title :
Relative value of clinical and transesophageal echocardiographic variables for risk stratification in patients with infective endocarditis.
Publication date :
1998
Journal title :
Clinical Cardiology: International Journal for Cardiovascular Diseases
ISSN :
0160-9289
eISSN :
1932-8737
Publisher :
John Wiley & Sons, Mahwah, United States - New Jersey
Volume :
21
Issue :
8
Pages :
572-8
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 07 November 2016

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