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著者: Franck Thuny, Giovanni Di Salvo, Giovanni Disalvo, Olivier Belliard, Jean-François Avierinos, Valeria Pergola, Valerie Rosenberg, Jean-Paul Casalta, Joanny Gouvernet, Geneviève Derumeaux, Diana Iarussi, Pierre Ambrosi, Raffaele Calabró, Raffaello Calabro, Alberto Riberi, Frédéric Collart, Dominique Metras, Hubert Lepidi, Didier Raoult, Jean-Robert Harle, Pierre-Jean Weiller, Ariel Cohen, Gilbert Habib
雑誌名: Circulation. 2005 Jul 5;112(1):69-75. doi: 10.1161/CIRCULATIONAHA.104.493155. Epub 2005 Jun 27.
Abstract/Text
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.
PMID 15983252 Circulation. 2005 Jul 5;112(1):69-75. doi: 10.1161/CIRCULATIONAHA.104.493155. Epub 2005 Jun 27.
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