Lancellotti P, Galiuto L, Albert A, Soyeur D, Piérard L A
Department of Cardiology, University of Liège, Belgium.
Clin Cardiol. 1998 Aug;21(8):572-8. doi: 10.1002/clc.4960210808.
Infective endocarditis remains a life-threatening disease, and its optimal management is of paramount importance. Transesophageal echocardiography (TEE) is useful for the diagnosis of endocarditis-induced lesions, but the prognostic significance of the method remains controversial.
The purpose of this study was to relate clinical and TEE characteristics to the occurrence of mortality and/or systemic embolization in a consecutive series of 45 patients with a diagnosis of infective endocarditis.
All patients underwent at least one monoplane TEE. Clinical data, episodes of embolization, and echocardiographic characteristics were prospectively recorded. Stepwise logistic discriminant analysis was performed to identify the independent variables that best predicted three binary outcomes: systemic embolization, death, and systemic embolization and/or death.
Twelve of the 45 patients (27%) died from the endocarditis. Significant univariate predictors of death were the presence of paravalvular abscess (p = 0.025), number of vegetations (p = 0.021), Staphylococcus aureus isolated in blood cultures (p = 0.002), medical treatment alone (p < 0.002), and systemic embolism (p < 0.001). In multivariate analysis, systemic embolism (chi 2 = 29.3; p < 0.01), echocardiographic evidence of paravalvular abscess (chi 2 = 5.6; p = 0.018), Staphylococcus aureus endocarditis (chi 2 = 5.5; p = 0.016), and medical treatment alone (chi 2 = 5.11; p = 0.024) emerged as optimal predictors of death. Systemic embolization occurred in 12 patients. Independent variables predicting systemic embolization were a total length of vegetations > 14 mm (p = 0.01), greater age (p = 0.02), and medical treatment alone (p = 0.03). When two or more vegetations were observed, the total length is the sum of the individual sizes. Independent risk factors for the development of systemic emboli and/or death as a combined end point were total length of vegetations on TEE (chi 2 = 6.4; p = 0.003) and medical treatment alone (chi 2 = 4.1; p = 0.047).
High-risk patients may be identified by the combination of clinical variables and TEE characteristics.
感染性心内膜炎仍然是一种危及生命的疾病，其最佳治疗至关重要。经食管超声心动图（TEE）对诊断心内膜炎引起的病变有用，但该方法的预后意义仍存在争议。
本研究的目的是在连续的45例诊断为感染性心内膜炎的患者中，将临床和TEE特征与死亡率和/或系统性栓塞的发生相关联。
所有患者至少接受一次单平面TEE检查。前瞻性记录临床数据、栓塞发作和超声心动图特征。进行逐步逻辑判别分析以确定最能预测三个二元结局的独立变量：系统性栓塞、死亡以及系统性栓塞和/或死亡。
45例患者中有12例（27%）死于心内膜炎。死亡的显著单变量预测因素包括瓣周脓肿的存在（p = 0.025）、赘生物数量（p = 0.021）、血培养中分离出金黄色葡萄球菌（p = 0.002）、单纯药物治疗（p < 0.002）和系统性栓塞（p < 0.001）。多变量分析中，系统性栓塞（卡方 = 29.3；p < 0.01）、瓣周脓肿的超声心动图证据（卡方 = 5.6；p = 0.018）、金黄色葡萄球菌心内膜炎（卡方 = 5.5；p = 0.016）和单纯药物治疗（卡方 = 5.11；p = 0.024）是死亡的最佳预测因素。12例患者发生系统性栓塞。预测系统性栓塞的独立变量包括赘生物总长度 > 14 mm（p = 0.01）、年龄较大（p = 0.02）和单纯药物治疗（p = 0.03）。当观察到两个或更多赘生物时，总长度为各个大小的总和。作为联合终点的系统性栓塞和/或死亡发生的独立危险因素是TEE上赘生物的总长度（卡方 = 6.4；p = 0.003）和单纯药物治疗（卡方 = 4.1；p = 0.047）。
通过临床变量和TEE特征的组合可以识别高危患者。
