Ali A S, Rosman H, Alam M, Singireddy S, Craven B, Lesch M
Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Clin Cardiol. 1998 Mar;21(3):191-3. doi: 10.1002/clc.4960210311.
The clinical impact of echocardiographic demonstration of a vegetation (Veg) in patients in whom infective endocarditis (IE) is not suspected has not previously been analyzed.
In this study, an echocardiographic database was interrogated to test whether discovery of a vegetation by echocardiography should result in treatment for endocarditis if IE is not suspected.
In all, 2,750 serial transthoracic echocardiograms (TTE) were reviewed to generate a list of reports containing the word Veg or thickening (Thk). A chart review of cases identified the impact the report had on patient management. To analyze reader bias due to echocardiographic requests, stating "rule out Veg or IE" as the reason for the study, an additional 1,000 serial TTE requests were segregated into two groups with and without this term. The incidence of the terms Veg or Thk in TTE reports of these groups was tabulated.
Of 2,750 reports, 20 contained the word Veg. Blood cultures were drawn in 16 of 20, with 7 of 16 being positive. Therapy for IE was initiated in 5 of 7 patients with positive cultures. Of 1,000 requests reviewed in the second phase, 24% of those with rule out Veg as the indication for TTE (n = 29) had Veg and 7% had Thk, while in 971 cases with other indications for TTE 0.2% had Veg and 9.3% had Thk.
Clinicians disregard TTE demonstration of Veg if clinical suspicion for IE is low. It is not clear whether the initial echo request biases the interpretation.
此前尚未分析过在未怀疑感染性心内膜炎（IE）的患者中，超声心动图显示赘生物（Veg）的临床影响。
在本研究中，对一个超声心动图数据库进行查询，以检验如果未怀疑IE，超声心动图发现赘生物是否应导致心内膜炎的治疗。
总共回顾了2750份连续的经胸超声心动图（TTE），以生成包含“Veg”或增厚（Thk）字样的报告列表。对病例进行图表回顾，确定该报告对患者管理的影响。为了分析由于超声心动图检查申请导致的读者偏差，将以“排除Veg或IE”作为研究理由的另外1000份连续TTE申请分为两组，一组有该术语，一组没有。将这些组的TTE报告中“Veg”或“Thk”术语的发生率制成表格。
在2750份报告中，20份包含“Veg”字样。20份中有16份进行了血培养，16份中有7份呈阳性。7例血培养阳性的患者中有5例开始了IE治疗。在第二阶段审查的1000份申请中，以排除Veg作为TTE指征的申请（n = 29）中有24%有Veg，7%有Thk，而在971例有其他TTE指征的病例中，0.2%有Veg，9.3%有Thk。
如果对IE的临床怀疑较低，临床医生会忽略TTE显示的Veg。尚不清楚最初的超声心动图检查申请是否会影响解释。
