Mügge A
St.-Josef-Hospital, Ruhr-Universität Bochum.
Herz. 2001 Sep;26(6):391-7. doi: 10.1007/pl00002043.
Patients with infective endocarditis are at risk for embolic complications. Emboli often occur very early in the course of endocarditis.
Pathologic substrate of emboli are vegetations which can be visualized by echocardiography with high sensitivity and accuracy. The question whether echocardiographically derived characteristics of vegetations such as size, mobility, location, and "consistency" poses an increased risk for complications, in particular arterial embolism, remains controversial. An analysis of pooled studies revealed an odds ratio of 2-3 for increased risk of embolization in the presence of a vegetation > 10 mm, particularly in mitral valve endocarditis.
However, because of poorly defined co-variables, lack of standardized methods for measurements, as well as a high overlap in the vegetation size between patients with and without embolic complications, no therapeutic implications can be drawn on the echocardiographic findings alone. It appears that an early diagnosis with initiation of an adequate antibiotic therapy is still the best prevention for embolic complications.
感染性心内膜炎患者有发生栓塞并发症的风险。栓子常在心内膜炎病程的极早期出现。
栓子的病理基础是赘生物，超声心动图能够以高灵敏度和准确性显示赘生物。超声心动图所显示的赘生物特征，如大小、活动度、位置和“质地”，是否会增加并发症尤其是动脉栓塞的风险，仍存在争议。一项汇总研究分析显示，存在直径>10mm的赘生物时，栓塞风险增加的比值比为2至3，在二尖瓣心内膜炎中尤为如此。
然而，由于协变量定义不明确、缺乏标准化测量方法，以及有栓塞并发症和无栓塞并发症患者的赘生物大小有很大重叠，仅根据超声心动图检查结果无法得出治疗意义。似乎早期诊断并开始适当的抗生素治疗仍是预防栓塞并发症的最佳方法。
