Heinle S, Wilderman N, Harrison J K, Waugh R, Bashore T, Nicely L M, Durack D, Kisslo J
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Am J Cardiol. 1994 Oct 15;74(8):799-801. doi: 10.1016/0002-9149(94)90438-3.
The purpose of this study was twofold: (1) to determine interobserver variability of echocardiographic characteristics of vegetations in patients with infective endocarditis, and (2) to assess the value of these vegetation characteristics in predicting embolic events. Although echocardiography contributes to the diagnosis of patients with infective endocarditis, its prognostic role in predicting embolic events is controversial. The echocardiograms of 41 patients with infective endocarditis were independently reviewed by 4 echocardiographers blinded to the clinical data. If a vegetation was present, the following characteristics were analyzed: involved site, size, mobility, shape, and pedunculated or sessile attachment. Each echocardiographer also made a "gestalt" estimate of embolic risk based on these vegetation characteristics. Interobserver agreement on vegetation characteristics and their relation to embolic events was then determined using kappa statistics and logistic regression analysis. Interobserver agreement was 98% with regard to echocardiographic vegetation presence and 97% with regard to the involved site. Of the 30 patients in whom vegetations were observed, complete observer agreement was achieved with regard to size in 22 (73%), mobility in 17 (57%), shape in 11 (37%), and attachment in 12 (40%). Vegetations with a maximal diameter of > 10 mm were associated with a 50% incidence of embolic events, compared with a 42% incidence of emboli in patients with vegetations measuring < or = 10 mm. Interobserver variability was great with respect to vegetation shape, mobility, and attachment characteristics. Echocardiographic vegetation characteristics were not helpful in defining the risk of embolic complications in patients with endocarditis.
（1）确定感染性心内膜炎患者赘生物超声心动图特征的观察者间变异性，以及（2）评估这些赘生物特征在预测栓塞事件中的价值。尽管超声心动图有助于感染性心内膜炎患者的诊断，但其在预测栓塞事件中的预后作用仍存在争议。4名对临床数据不知情的超声心动图医生独立回顾了41例感染性心内膜炎患者的超声心动图。如果存在赘生物，则分析以下特征：受累部位、大小、活动度、形状以及有蒂或无蒂附着。每位超声心动图医生还根据这些赘生物特征对栓塞风险进行了“整体”评估。然后使用kappa统计和逻辑回归分析确定观察者间在赘生物特征及其与栓塞事件关系方面的一致性。观察者间在超声心动图赘生物存在方面的一致性为98%，在受累部位方面为97%。在观察到赘生物的30例患者中，22例（73%）在大小方面、17例（57%）在活动度方面、11例（37%）在形状方面以及12例（40%）在附着方面达成了完全的观察者一致。最大直径>10 mm的赘生物与50%的栓塞事件发生率相关，而直径≤10 mm的赘生物患者的栓塞发生率为42%。观察者间在赘生物形状、活动度和附着特征方面的变异性很大。超声心动图赘生物特征无助于确定心内膜炎患者发生栓塞并发症的风险。
