Stewart J A, Silimperi D, Harris P, Wise N K, Fraker T D, Kisslo J A
Circulation. 1980 Feb;61(2):374-80. doi: 10.1161/01.cir.61.2.374.
Eighty-seven patients with the clinical syndrome of infective endocarditis were examined by M-mode and two-dimensional echocardiography. Patients were divided into two groups based on the presence or absence of echocardiographically detected vegetative lesions. Group 1 consisted of 47 patients with one or more vegetations. Group 2 consisted of 40 patients without evidence of vegetations. Group 1 patients had a higher rate of complications: emboli, congestive heart failure and the need for surgical intervention. Analysis of morphologic characteristics of the vegetations in group 1 was of no predictive value for complications in individual patients. Two-thirds of the vegetations persisted unaltered well beyond the period of bacteriologic cure without significant complications. No characteristic alteration of the vegetations predicted the efficacy of medical therapy. Although the detection of vegetations by echocardiography in patients with the clinical syndrome of endocarditis clearly identifies a subgroup at risk for complications, decisions regarding clinical management made solely on the basis of the presence or absence of vegetative lesions are hazardous. Management of such patients must continue to be based on the clinical integration of multiple factors.
87例患有感染性心内膜炎临床综合征的患者接受了M型和二维超声心动图检查。根据超声心动图检测到的赘生物病变情况，将患者分为两组。第1组由47例有一个或多个赘生物的患者组成。第2组由40例无赘生物证据的患者组成。第1组患者的并发症发生率更高：栓塞、充血性心力衰竭以及手术干预的需求。对第1组赘生物形态学特征的分析对个体患者的并发症没有预测价值。三分之二的赘生物在细菌学治愈期过后很长时间仍未改变，且无明显并发症。赘生物没有特征性改变可预测药物治疗的疗效。尽管超声心动图在患有心内膜炎临床综合征的患者中检测到赘生物明确识别出了一个有并发症风险的亚组，但仅根据赘生物病变的有无做出临床管理决策是有风险的。这类患者的管理必须继续基于多种因素的临床综合判断。
