Karalis D G, Blumberg E A, Vilaro J F, Covalesky V A, Wahl J M, Chandrasekaran K, Mintz G S
Department of Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania 19102.
Am J Med. 1991 Feb;90(2):193-7.
Doppler ultrasound is a sensitive modality for detecting and quantitating valvular regurgitation in patients with infective endocarditis. Because valvular regurgitation leads to heart failure, we evaluated the prognostic significance of Doppler-detected valvular regurgitation in patients with endocarditis who had not yet developed clinical heart failure.
We reviewed the medical records of 65 patients with a clinical diagnosis of infective endocarditis from May 1985 to March 1990. A total of 49 patients were included in the study: 33 patients with native valve endocarditis and 16 patients with prosthetic valve endocarditis. The initial Doppler echocardiogram was examined in these patients to determine the presence and degree of valvular regurgitation.
Significant (moderate to severe) valvular regurgitation was detected in 23 (47%) patients. The presence or absence of significant valvular regurgitation did not predict the development of congestive heart failure, the need for surgery, or death (p = NS). The development of congestive heart failure was significantly associated with the need for surgery (p less than 0.0001) and death (p less than 0.05).
We conclude that the detection of significant valvular regurgitation in patients with infective endocarditis who have not yet developed heart failure is not predictive of future complications nor does the absence of significant valvular regurgitation identify a group of patients with a more favorable prognosis. In our series, patients who developed congestive heart failure had a significantly higher incidence of surgery and death. Therefore, decisions regarding clinical management in patients with infective endocarditis should not be made solely on the presence or absence of echocardiographically detected valvular regurgitation.
多普勒超声是检测和定量感染性心内膜炎患者瓣膜反流的敏感方法。由于瓣膜反流会导致心力衰竭，我们评估了在尚未发生临床心力衰竭的感染性心内膜炎患者中，多普勒检测到的瓣膜反流的预后意义。
我们回顾了1985年5月至1990年3月期间65例临床诊断为感染性心内膜炎患者的病历。共有49例患者纳入研究：33例为天然瓣膜心内膜炎患者，16例为人工瓣膜心内膜炎患者。对这些患者进行了初次多普勒超声心动图检查，以确定瓣膜反流的存在和程度。
在23例（47%）患者中检测到显著（中度至重度）瓣膜反流。显著瓣膜反流的有无并不能预测充血性心力衰竭的发生、手术需求或死亡（p=无显著性差异）。充血性心力衰竭的发生与手术需求（p<0.0001）和死亡（p<0.05）显著相关。
我们得出结论，在尚未发生心力衰竭的感染性心内膜炎患者中，检测到显著瓣膜反流并不能预测未来并发症，显著瓣膜反流的缺失也不能确定一组预后较好的患者。在我们的系列研究中，发生充血性心力衰竭的患者手术和死亡的发生率显著更高。因此，对于感染性心内膜炎患者的临床管理决策不应仅基于超声心动图检测到的瓣膜反流的有无。
