Rohmann S, Erbel R, Görge G, Makowski T, Mohr-Kahaly S, Nixdorff U, Drexler M, Meyer J
II. Medical Clinic, Johannes Gutenberg University, Mainz, Germany.
Eur Heart J. 1992 Apr;13(4):446-52. doi: 10.1093/oxfordjournals.eurheartj.a060195.
Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction and congestive heart failure being more common in patients with echocardiographically discernible vegetations. The transoesophageal approach affords consistently high quality images with excellent structural resolution. Two-hundred and eighty-one patients with clinically suspected infective endocarditis were studied, to evaluate the prognostic value of ascertaining the site of vegetations. Among them were 118 patients with vegetations attached to the aortic or mitral valve. These patients were followed for a mean period of 14 months. Mitral valve vegetations were associated with a significantly higher incidence of embolic events than vegetations on aortic valves (25% vs 9.7%). The incidence of abscess formation was higher in aortic than in mitral valve endocarditis (6% vs 0%), as were the need for surgical intervention (11% vs 5.5%) and mortality (1.6% vs 0%) respectively). Bivalvular endocarditis was associated with an increased rate of complications: embolism (50%), abscess formation (15%), surgery (35%) and mortality (10%). By multivariate analysis, echocardiographically accessible risk factors for subsequent embolism were a vegetation size of more than 10 mm and mitral valve involvement. Risk factors associated with in-hospital fatality were embolism, a vegetation size of more than 10 mm, and Staphylococcus aureus infection. Our data suggest that the site influences both the rate and the type of complications. Precise echocardiographic visualization of vegetations helps to stratify patients into a high-risk sub-group, perhaps warranting early prophylactic surgical intervention. Transoesophageal echocardiography may play an important role in assessing the clinical outcome for these patients.
感染性心内膜炎与显著的发病率和死亡率相关，在经超声心动图可识别赘生物的患者中，瓣膜破坏和充血性心力衰竭更为常见。经食管途径能持续提供高质量图像，具有出色的结构分辨率。对281例临床疑似感染性心内膜炎的患者进行了研究，以评估确定赘生物部位的预后价值。其中118例患者的赘生物附着于主动脉瓣或二尖瓣。这些患者平均随访14个月。二尖瓣赘生物比主动脉瓣赘生物的栓塞事件发生率显著更高（25%对9.7%）。主动脉瓣心内膜炎的脓肿形成发生率高于二尖瓣心内膜炎（6%对0%），手术干预的需求（11%对5.5%）和死亡率（1.6%对0%）也是如此。双瓣膜心内膜炎与并发症发生率增加相关：栓塞（50%）、脓肿形成（15%）、手术（35%）和死亡率（10%）。通过多变量分析，超声心动图可检测到的后续栓塞危险因素是赘生物大小超过10毫米和二尖瓣受累。与院内死亡相关的危险因素是栓塞、赘生物大小超过10毫米和金黄色葡萄球菌感染。我们的数据表明，部位会影响并发症的发生率和类型。赘生物的精确超声心动图可视化有助于将患者分层为高危亚组，可能需要早期预防性手术干预。经食管超声心动图可能在评估这些患者的临床结局中发挥重要作用。
