Barretta Giovanni, Sisani Stefano, Maragoni Giorgio
U.O. di Cardiologia, Ospedale Civile, ASL 3-Regione Umbria, Spoleto, PG.
Ital Heart J Suppl. 2003 Dec;4(12):935-57.
Infective endocarditis is a rare but serious disease. The incidence in western countries is 1.7-6.2 cases/100,000 per year. The mortality rate today is 20-40%. The Duke University incorporates echocardiographic findings as one of the major criteria in the diagnosis of infective endocarditis. In case of suspected infective endocarditis, echocardiography is used to: 1) detect and characterize endocarditic vegetations; 2) detect complications; 3) conduct follow-up after treatment. Sensitivity for detection of vegetations in native-valve endocarditis is < 65% by transthoracic echocardiography, whereas it is 82-100% by transesophageal echocardiography; in infective endocarditis on prosthetic valves, sensitivity is 16-36 and 82-96%, respectively. Echocardiographic studies have demonstrated that highly mobile vegetations with a diameter of > 10 mm are more likely to cause complications (embolism, heart failure, need for surgery, and death). Another important advantage offered by echocardiography is the ability to accurately detect cardiac complications of infective endocarditis: valvular regurgitation, valve rupture, periannular abscess, prosthetic dehiscence, rupture of cardiac fibrosa, septal abscess, hemopericardium, and myocardial infarction. The sensitivity of transthoracic echocardiography for the detection of periannular abscess is 28% whereas that of transesophageal echocardiography is 87%. Finally, echocardiography has an invaluable role in indicating if surgery is required in cases of infective endocarditis with severe complications.
感染性心内膜炎是一种罕见但严重的疾病。西方国家的发病率为每年1.7 - 6.2例/10万。如今的死亡率为20% - 40%。杜克大学将超声心动图检查结果作为感染性心内膜炎诊断的主要标准之一。在疑似感染性心内膜炎的情况下,超声心动图用于:1)检测和描述心内膜赘生物;2)检测并发症;3)治疗后进行随访。经胸超声心动图检测天然瓣膜心内膜炎赘生物的敏感性<65%,而经食管超声心动图的敏感性为82% - 100%;在人工瓣膜感染性心内膜炎中,敏感性分别为16% - 36%和82% - 96%。超声心动图研究表明,直径>10 mm的高度活动赘生物更有可能导致并发症(栓塞、心力衰竭、手术需求和死亡)。超声心动图的另一个重要优势是能够准确检测感染性心内膜炎的心脏并发症:瓣膜反流、瓣膜破裂、瓣周脓肿、人工瓣膜裂开、心脏纤维层破裂、间隔脓肿、心包积血和心肌梗死。经胸超声心动图检测瓣周脓肿的敏感性为28%,而经食管超声心动图的敏感性为87%。最后,超声心动图在指示伴有严重并发症的感染性心内膜炎病例是否需要手术方面具有不可估量的作用。