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(Circulation. 2005;112:69-75.)
© 2005 American Heart Association, Inc.

Imaging

Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography

A Prospective Multicenter Study

Franck Thuny, MD; Giovanni Disalvo, MD; Olivier Belliard, MD; Jean-François Avierinos, MD; Valeria Pergola, MD; Valerie Rosenberg, MD; Jean-Paul Casalta, MD; Joanny Gouvernet, MD, PhD; Geneviève Derumeaux, MD; Diana Iarussi, MD; Pierre Ambrosi, MD; Raffaello Calabro, MD; Alberto Riberi, MD; Frédéric Collart, MD; Dominique Metras, MD; Hubert Lepidi, MD; Didier Raoult, MD, PhD; Jean-Robert Harle, MD; Pierre-Jean Weiller, MD; Ariel Cohen, MD; Gilbert Habib, MD

From the Departments of Cardiology of La Timone Hospital, Marseille, France (F.T., J.A., J.C., J.G., P.A., A.R., F.C., D.M., H.L., D.R., J.H., P.W., G.H.); Saint-Antoine Hospital, Paris, France (O.B., V.R., A.C.); Charles Nicolle Hospital, Rouen, France (G. Derumeaux); and Second University, Naples, Italy (G. Disalvo, V.P., D.I., R.C.).

Correspondence to Dr Gilbert Habib, Département de Cardiologie, Hôpital de la Timone, Boulevard Jean Moulin, 13005, Marseille, France. E-mail gilbert.habib{at}ap-hm.fr, gilbert.habib@free.fr

Received February 14, 2004; de novo received July 18, 2004; revision received February 12, 2005; accepted March 11, 2005.

Background— The incidence of embolic events (EE) and death is still high in patients with infective endocarditis (IE), and data about predictors of these 2 major complications are conflicting. Moreover, the exact role of echocardiography in risk stratification is not well defined.

Methods and Results— In a multicenter prospective European study, including 384 consecutive patients (aged 57±17 years) with definite IE according to Duke University criteria, we tested clinical, microbiological, and echocardiographic data as potential predictors of EE and 1-year mortality. Transesophageal echocardiography was performed in all patients. Embolism occurred before or after IE diagnosis (total-EE) in 131 patients (34.1%) and after initiation of antibiotic therapy (new-EE) in 28 patients (7.3%). Staphylococcus aureus and Streptococcus bovis were independently associated with total-EE, whereas vegetation length >10 mm and severe vegetation mobility were predictors of new-EE, even after adjustment for S aureus and S bovis. One-year mortality was 20.6%. In multivariable analysis, independently of the other predictors of death (age, female sex, creatinine serum >2 mg/L, moderate or severe congestive heart failure, and S aureus) and comorbidity, vegetation length >15 mm was a predictor of 1-year mortality (adjusted relative risk=1.8; 95% CI, 1.10 to 2.82; P=0.02).

Conclusions— In IE, vegetation length is a strong predictor of new-EE and mortality. In combination with clinical and microbiological findings, echocardiography may identify high-risk patients who will need a more aggressive therapeutic strategy.

Key Words: echocardiography • embolism • endocardium • prognosis

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