The clinical and echocardiographic characteristics of patients with infective endocarditis hospitalized at a large medical center between January 1984 and December 1988 were evaluated. Included were 30 patients with a definite diagnosis of infective endocarditis, all of whom underwent at least one echocardiographic examination during their hospital course. Clinical characteristics of the endocarditis group included: presence of previous valvular heart disease (80%), fever (100%), splenomegaly (43%), petechiae (20%), embolic phenomena (23%), and prehospitalization disease duration of a 12-day period. Streptococcus viridans was the most frequent causative pathogen (36.6%); however, 10 patients (33%) had staphylococci isolated from their blood cultures. Rheumatic heart disease was the most common underlying valvular disease (50%). However, congenital heart disease (20%) and ischemic heart disease (13%) were also common. Three patients (10%) had surgery and subsequently recovered (valve replacement - 1; vegetectomy - 1; and vegetectomy plus correction of partial atrioventricular canal malformation - 1). Two patients (16.7%) died during hospitalization. The echocardiographic features in these patients and those of 30 randomly selected age-matched patients with valvular heart disease, who served as controls, were blindly evaluated by two observers. Echocardiographic results were graded in 5 groups according to the probability of having vegetations. Echocardiographic images were graded as positive for the presence of vegetations in 17/30 (56.6%) of the echocarditis patients and in only 1 of the control group (p < 0.001). Diagnosis was especially difficult in patients with prosthetic valves and in those with heavily calcified valves. We conclude that the clinical picture of endocarditis is indeed changing. Conventional echocardiography is a useful noninvasive tool for the detection of vegetations in native valves. Transesophageal echocardiography (TEE) is recommended for patients with prosthetic or heavily calcified valves.
|Number of pages||7|
|Journal||Journal of Cardiovascular Diagnosis and Procedures|
|State||Published - 1993|