Circulation, Vol 61, 374-380, Copyright © 1980 by American Heart Association
JA Stewart, D Silimperi, P Harris, NK Wise, TD Fraker Jr and JA Kisslo
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.
ARTICLES
Echocardiographic documentation of vegetative lesions in infective endocarditis: clinical implications
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