Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK.
Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Heart Lung Circ. 2021 Jun;30(6):854-860. doi: 10.1016/j.hlc.2020.10.028. Epub 2020 Dec 3.
The mortality of patients with infective endocarditis (IE) is high. The management of patients with large vegetations is controversial. This study sought to investigate the association of vegetation size on outcomes including valve destruction, embolism and mortality.
One hundred and forty-two (142) patients with definite IE and transoesophageal echocardiography (TEE) imaging available for analysis were identified and data retrospectively reviewed. Vegetation length, width and area were measured. Severe valve destruction was defined as the composite of one or more of severe valve regurgitation, abscess, pseudoaneurysm, perforation or fistula. Associations with 6-month mortality were identified by Cox regression analysis. Eighty (80) (56.3%) patients had evidence of valve destruction on TEE. Vegetation length ≥10 mm and vegetation area ≥50 mm were significantly associated with increased risk of valve destruction, (both odds ratio OR 1.21, p=0.03 and p=0.02 respectively). Thirty-nine (39) (72.2%) patients who had an embolic event, did so prior initiation of antibiotics. Six (6)-month mortality was 18.3%. In the surgically managed group, vegetation size was not associated with mortality. In the medically managed group, vegetation area (mm) was associated with increased mortality (HR 1.01, p<0.01) along with age (HR 1.06, p=0.03).
Vegetation length ≥10 mm or area ≥50 mm are associated with increased risk of valve destruction. Vegetation size may also predict mortality in medically managed but not surgically managed patients with IE. Further studies to evaluate whether surgery in patients with large vegetation size improves outcomes is warranted.
感染性心内膜炎（IE）患者的死亡率较高。对于大赘生物患者的治疗存在争议。本研究旨在探讨赘生物大小与瓣膜破坏、栓塞和死亡率等结局的关系。
共纳入 142 例经经食管超声心动图（TEE）检查确诊为 IE 且资料完整的患者，回顾性分析数据。测量赘生物的长度、宽度和面积。严重瓣膜破坏定义为一种或多种严重瓣膜反流、脓肿、假性动脉瘤、穿孔或瘘管的复合表现。通过 Cox 回归分析确定与 6 个月死亡率相关的因素。80 例（56.3%）患者 TEE 检查显示有瓣膜破坏证据。赘生物长度≥10mm 和赘生物面积≥50mm 与瓣膜破坏风险增加显著相关（OR 分别为 1.21，p=0.03 和 p=0.02）。39 例（72.2%）患者发生栓塞事件，均在开始使用抗生素之前发生。6 个月死亡率为 18.3%。在手术治疗组中，赘生物大小与死亡率无关。在药物治疗组中，赘生物面积（mm）与死亡率增加相关（HR 1.01，p<0.01），年龄也与死亡率增加相关（HR 1.06，p=0.03）。
赘生物长度≥10mm 或面积≥50mm 与瓣膜破坏风险增加相关。在药物治疗而非手术治疗的 IE 患者中，赘生物大小也可能预测死亡率。需要进一步研究评估大赘生物患者手术治疗是否可以改善结局。
