Vieira Marcelo Luiz Campos, Grinberg Max, Pomerantzeff Pablo M A, Andrade José L de, Mansur Alfredo J
Instituto do Coração, Hospital das Clínicas, FMUSP, São Paulo, Brazil.
Arq Bras Cardiol. 2004 Sep;83(3):197-202; 191-6. doi: 10.1590/s0066-782x2004001500003. Epub 2004 Sep 13.
To assess the echocardiographic findings in patients with suspected infective endocarditis.
Two hundred sixty-two patients with suspected infective endocarditis underwent transthoracic and transesophageal echocardiographic investigation. Images of vegetations, valvular abscesses, and acute periprosthetic insufficiency were analyzed, and the correlation with clinical and laboratory data, diagnostic category, and hospital evolution was assessed.
The diagnosis of endocarditis was categorized as defined in 127 (47.8%) episodes, possible in 81 (30.4%), and rejected in 58 (21.8%). In patients with the defined diagnosis, the following images were identified: 135 vegetations, 37 abscesses, and 6 periprosthetic insufficiencies. Vegetations were more frequent in patients with endocarditis due to streptococci of the viridans group and enterococci (P=0.02), and with symptom duration < 10 days (P=0.001). Abscesses were more frequent in patients with symptom duration < 10 days (P=0.001). Periprosthetic insufficiency was associated with a greater need for surgical treatment (P=0.001). In patients with the possible diagnosis of endocarditis, 8 echocardiographic images considered compatible with vegetations were identified. In patients whose diagnosis of endocarditis was rejected, no vegetations, valvular abscesses, or periprosthetic insufficiencies were demonstrated.
Our echocardiographic findings varied according to the diagnostic category. The contribution to both the diagnosis and prognostic evaluation should consider the pretest probability of the diagnosis of infective endocarditis.
评估疑似感染性心内膜炎患者的超声心动图检查结果。
262例疑似感染性心内膜炎患者接受了经胸和经食管超声心动图检查。分析赘生物、瓣膜脓肿和人工瓣膜急性功能不全的图像，并评估其与临床及实验室数据、诊断类别和住院病情演变的相关性。
心内膜炎的诊断分类为确诊127例（47.8%），可能127例（47.8%），排除58例（21.8%）。在确诊患者中，发现以下图像：135个赘生物、37个脓肿和6例人工瓣膜功能不全。草绿色链球菌和肠球菌所致心内膜炎患者以及症状持续时间<10天的患者中赘生物更为常见（P=0.02）（P=0.001）。症状持续时间<10天的患者中脓肿更为常见（P=0.001）。人工瓣膜功能不全与更大的手术治疗需求相关（P=0.001）。在可能诊断为心内膜炎的患者中，发现8个被认为与赘生物相符的超声心动图图像。在心内膜炎诊断被排除的患者中，未发现赘生物、瓣膜脓肿或人工瓣膜功能不全。
我们的超声心动图检查结果因诊断类别而异。对诊断和预后评估的贡献应考虑感染性心内膜炎诊断的验前概率。
