Steckelberg J M, Murphy J G, Ballard D, Bailey K, Tajik A J, Taliercio C P, Giuliani E R, Wilson W R
Mayo Clinic and Foundation, Rochester, Minnesota.
Ann Intern Med. 1991 Apr 15;114(8):635-40. doi: 10.7326/0003-4819-114-8-635.
To determine whether vegetations visualized on two-dimensional echocardiography are an independent risk factor for the development of subsequent emboli in patients with infective endocarditis and to assess the timing of emboli relative to the initiation of antimicrobial therapy.
Investigator-blinded, retrospective incidence cohort study.
Tertiary referral center.
Patients with left-sided native valve infective endocarditis who had two-dimensional echocardiography within 72 hours of beginning antimicrobial therapy.
The crude incidence rate of first embolic events in patients receiving antimicrobial therapy was 6.2 per 1000 patient-days (95% CI, 4.2 to 9.2). The rates in patients with and without vegetations were 7.1 and 4.9 per 1000 patient-days, respectively (incidence rate ratio, 1.4; 95% CI, 0.6 to 3.3). The relation between vegetations and risk for emboli was microorganism-dependent: Stratified incidence rate ratios were 6.9 (95% CI, 1.1 to 42.5; P less than 0.05) and 1.0 (95% CI, 0.2 to 3.9) for viridans streptococcal and Staphylococcus aureus endocarditis, respectively. The rate of first embolic events diminished over time (P less than 0.001), falling from 13 per 1000 patient-days during the first week of therapy to less than 1.2 per 1000 patient-days after completion of the second week of therapy.
Overall, the presence of vegetations on echocardiography was not associated with a significantly higher risk for embolus in patients with left-sided native valve infective endocarditis. The relative risk for embolic events associated with echocardiographically visualized vegetations may be microorganism-dependent, with a significantly increased risk seen only in patients with viridans streptococcal infection. The rate of embolic events declines with time after initiation of antimicrobial treatment.
确定二维超声心动图显示的赘生物是否为感染性心内膜炎患者发生后续栓塞的独立危险因素，并评估栓塞相对于抗菌治疗开始时间的情况。
研究者设盲的回顾性发病率队列研究。
三级转诊中心。
在开始抗菌治疗72小时内接受二维超声心动图检查的左侧天然瓣膜感染性心内膜炎患者。
接受抗菌治疗患者首次栓塞事件的粗发病率为每1000患者日6.2例（95%CI，4.2至9.2）。有赘生物和无赘生物患者的发病率分别为每1000患者日7.1例和4.9例（发病率比，1.4；95%CI，0.6至3.3）。赘生物与栓塞风险之间的关系取决于微生物：草绿色链球菌和金黄色葡萄球菌心内膜炎的分层发病率比分别为6.9（95%CI，1.1至42.5；P<0.05）和1.0（95%CI，0.2至3.9）。首次栓塞事件的发生率随时间下降（P<0.001），从治疗第一周的每1000患者日13例降至治疗第二周结束后的每1000患者日不到1.2例。
总体而言，二维超声心动图显示有赘生物与左侧天然瓣膜感染性心内膜炎患者发生栓塞的风险显著升高无关。与超声心动图显示的赘生物相关的栓塞事件相对风险可能取决于微生物，仅在草绿色链球菌感染患者中可见风险显著增加。抗菌治疗开始后，栓塞事件的发生率随时间下降。
