In:
Echocardiography, Wiley, Vol. 36, No. 4 ( 2019-04), p. 742-751
Abstract:
Vegetation size is a prognostic predictor in infective endocarditis ( IE ) and guides surgical management. The aim of this study was to evaluate the accuracy of real‐time 3‐dimensional transesophageal echocardiography ( RT 3 DTEE ) compared to 2 DTEE in the diagnosis and characterization of vegetation, as well as its potential clinical impact. Methods Two hundred and three consecutive patients with IE were recruited (2009–2016) and retrospectively analyzed. Vegetation diameters and area from 68 patients were measured by 2 DTEE and RT 3 DTEE at admission. The association between size and systemic embolisms was evaluated with logistic regression models. Differences in the discriminative power for the best dimensions’ cutoff points were assessed by comparing the area under the ROC curves ( AUC ). Results Vegetation size and area were larger by RT 3 DTEE ( P 〈 0.001) than by 2 DTEE , and RT 3 DTEE was especially relevant in the characterization of nonfiliform vegetation, Morphology was strongly associated with friability, being sessile vegetation less likely to embolize, compared to filiform and raceme‐shaped ones (15.4% vs 46% vs 50%). Major diameter by RT 3 DTEE had better embolic predictive performance than 2 DTEE ( AUC 0.76 [0.57–0.89] vs 0.71 [0.53–0.86] ; P = 0.611). The best cutoff points associated with embolic events during the infection were 17 mm for RT 3 DTEE and 15 mm for 2 DTEE . Based exclusively on vegetation size, the proportion of patients meeting a surgical indication according to current guidelines is higher using RT 3 DTEE . Conclusions RT 3 DTEE allows a better characterization of IE vegetation than 2 DTEE , what may have a clinical impact on surgical management and also prognostic due to a more accurate prediction of embolic risk.
Type of Medium:
Online Resource
ISSN:
0742-2822
,
1540-8175
DOI:
10.1111/echo.2019.36.issue-4
Language:
English
Publisher:
Wiley
Publication Date:
2019
detail.hit.zdb_id:
2041033-5
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