Tischler M D, Vaitkus P T
Cardiology Unit, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, USA.
J Am Soc Echocardiogr. 1997 Jun;10(5):562-8. doi: 10.1016/s0894-7317(97)70011-7.
To clarify whether echocardiographic detection of a vegetation 10 mm or larger in size in patients with left-sided infective endocarditis poses an increased risk for complications, we performed a meta-analysis of English-language publications identified by a computerized search of the key words infective endocarditis and echocardiography. A pooled odds ratio was calculated by using the Robins, Greenland, and Breslow estimate of variance. The pooled odds ratio for increased risk of systemic embolization in the presence of a vegetation >10 mm (10 studies, 738 patients) was 2.80 (95% confidence interval [CI] 1.95 to 4.02; p < 0.01). The odds ratio of requiring valve-replacement surgery (seven studies, 549 patients) was 2.95 (95% CI 1.90 to 4.58; p < 0.01). The odds ratio of death (six studies, 476 patients) was 1.55 (95% CI 0.92 to 2.60; p = 0.10). Thus this analysis supports the hypothesis that echocardiographically detected left-sided vegetations >10 mm pose a significantly increased risk of (1) systemic embolization and (2) a need for valve-replacement surgery than cases where either no or smaller vegetations are detected.
为了阐明在左侧感染性心内膜炎患者中，经超声心动图检测到直径10毫米或更大的赘生物是否会增加并发症风险，我们对通过计算机检索关键词“感染性心内膜炎”和“超声心动图”所确定的英文出版物进行了荟萃分析。使用Robins、Greenland和Breslow方差估计值计算合并比值比。存在直径>10毫米赘生物（10项研究，738例患者）时全身栓塞风险增加的合并比值比为2.80（95%置信区间[CI]1.95至4.02；p<0.01）。需要进行瓣膜置换手术的比值比（7项研究，549例患者）为2.95（95%CI 1.90至4.58；p<0.01）。死亡的比值比（6项研究，476例患者）为1.55（95%CI 0.92至2.60；p = 0.10）。因此，该分析支持以下假设：经超声心动图检测到的左侧直径>10毫米的赘生物，与未检测到赘生物或检测到较小赘生物的情况相比，发生（1）全身栓塞和（2）需要进行瓣膜置换手术的风险显著增加。
