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Abstract：
BACKGROUND: Infective endocarditis (IE) is a life-threatening infection with an annual mortality of 40%. Embolic events reported in up to 80% of patients. Vegetations of > 10 mm size are associated with increased embolic events and poor prognosis. There is a paucity of literature on the association of multiple vegetations with outcome.
OBJECTIVE: To study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetations.
METHODS: In this retrospective, single-center, cohort study patients diagnosed with IE were recruited from June 2017 to June 2019. A total of 84 patients were diagnosed to have IE, of whom 67 with vegetation were identified. Baseline demographic, clinical, laboratory, and ECHO parameters were reviewed. Outcomes that were studied included recurrent admission, embolic phenomenon, and mortality.
RESULTS: Twenty-three (34%) patients were noted to have multiple vegetations, 13 (56.5%) were male and 10 (43.5%) were female. The mean age of these patients was 50. Eight (35%) had a prior episode of IE. ECHO features of moderate to severe valvular regurgitation [odds ratio (OR) = 4], presence of pacemaker lead (OR = 4.8), impaired left ventricle (LV) relaxation (OR = 4), and elevated pulmonary artery systolic pressure (PASP) (OR = 2.2) are associated with higher odds of multiple vegetations. Of these moderate to severe valvular regurgitation (P = 0.028), pacemaker lead (P = 0.039) and impaired relaxation (P = 0.028) were statistically significant. These patients were noted to have an increased association of recurrent admissions (OR = 3.6), recurrent bacteremia (OR = 2.4), embolic phenomenon (OR = 2.5), intensive care unit stay (OR = 2.8), hypotension (OR = 2.1), surgical intervention (OR = 2.8) and device removal (OR = 4.8). Of this device removal (P = 0.039) and recurrent admissions (P = 0.017) were statistically significant.
CONCLUSIONS: This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations. ECHO features of moderate to severe regurgitation, presence of pacemaker lead, impaired LV relaxation, and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.
OBJECTIVE: To study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetations.
METHODS: In this retrospective, single-center, cohort study patients diagnosed with IE were recruited from June 2017 to June 2019. A total of 84 patients were diagnosed to have IE, of whom 67 with vegetation were identified. Baseline demographic, clinical, laboratory, and ECHO parameters were reviewed. Outcomes that were studied included recurrent admission, embolic phenomenon, and mortality.
RESULTS: Twenty-three (34%) patients were noted to have multiple vegetations, 13 (56.5%) were male and 10 (43.5%) were female. The mean age of these patients was 50. Eight (35%) had a prior episode of IE. ECHO features of moderate to severe valvular regurgitation [odds ratio (OR) = 4], presence of pacemaker lead (OR = 4.8), impaired left ventricle (LV) relaxation (OR = 4), and elevated pulmonary artery systolic pressure (PASP) (OR = 2.2) are associated with higher odds of multiple vegetations. Of these moderate to severe valvular regurgitation (P = 0.028), pacemaker lead (P = 0.039) and impaired relaxation (P = 0.028) were statistically significant. These patients were noted to have an increased association of recurrent admissions (OR = 3.6), recurrent bacteremia (OR = 2.4), embolic phenomenon (OR = 2.5), intensive care unit stay (OR = 2.8), hypotension (OR = 2.1), surgical intervention (OR = 2.8) and device removal (OR = 4.8). Of this device removal (P = 0.039) and recurrent admissions (P = 0.017) were statistically significant.
CONCLUSIONS: This study highlights the associations of ECHO predictors and outcomes in patients with IE having multiple vegetations. ECHO features of moderate to severe regurgitation, presence of pacemaker lead, impaired LV relaxation, and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations.
摘要：
背景：感染性心内膜炎（IE）是一种威胁生命的感染，年死亡率为40％。多达80%的患者报告了栓塞事件。>10mm大小的植被与栓塞事件增加和预后不良相关。关于多种植被与结果的关联的文献很少。
目的：研究与多种植被存在相关的超声心动图（ECHO）特征和结局。
方法：在本回顾性研究中，单中心,队列研究纳入2017年6月至2019年6月诊断为IE的患者.共有84名患者被诊断为IE，其中67人被确定为植被。基线人口统计，临床,实验室,并对ECHO参数进行了综述。研究的结果包括反复入院，栓塞现象,和死亡率。
结果：发现23例（34%）患者有多个植被，男性13人（56.5%），女性10人（43.5%）。这些患者的平均年龄为50岁。八个（35％）的人先前有IE发作。中度至重度瓣膜返流的ECHO特征[比值比（OR）=4]，存在起搏器导线（OR=4.8），左心室（LV）松弛受损（OR=4），和肺动脉收缩压（PASP）升高（OR=2.2）与多个植被的较高几率相关。在这些中度至重度瓣膜返流中（P=0.028），起搏器导线(P=0.039)和舒张功能受损(P=0.028)有统计学意义。注意到这些患者与反复入院的关联增加（OR=3.6），复发性菌血症（OR=2.4），栓塞现象（OR=2.5），重症监护病房住院（OR=2.8），低血压（OR=2.1），手术干预(OR=2.8)和设备移除(OR=4.8)。该设备的移除（P=0.039）和反复入院（P=0.017）具有统计学意义。
结论：本研究强调了具有多个植被的IE患者的ECHO预测因子与预后的关联。中重度反流的ECHO特征，起搏器导线的存在,左心室松弛受损，和升高的PASP和包括反复入院和设备移除在内的结局被发现与多个植被相关。
目的：研究与多种植被存在相关的超声心动图（ECHO）特征和结局。
方法：在本回顾性研究中，单中心,队列研究纳入2017年6月至2019年6月诊断为IE的患者.共有84名患者被诊断为IE，其中67人被确定为植被。基线人口统计，临床,实验室,并对ECHO参数进行了综述。研究的结果包括反复入院，栓塞现象,和死亡率。
结果：发现23例（34%）患者有多个植被，男性13人（56.5%），女性10人（43.5%）。这些患者的平均年龄为50岁。八个（35％）的人先前有IE发作。中度至重度瓣膜返流的ECHO特征[比值比（OR）=4]，存在起搏器导线（OR=4.8），左心室（LV）松弛受损（OR=4），和肺动脉收缩压（PASP）升高（OR=2.2）与多个植被的较高几率相关。在这些中度至重度瓣膜返流中（P=0.028），起搏器导线(P=0.039)和舒张功能受损(P=0.028)有统计学意义。注意到这些患者与反复入院的关联增加（OR=3.6），复发性菌血症（OR=2.4），栓塞现象（OR=2.5），重症监护病房住院（OR=2.8），低血压（OR=2.1），手术干预(OR=2.8)和设备移除(OR=4.8)。该设备的移除（P=0.039）和反复入院（P=0.017）具有统计学意义。
结论：本研究强调了具有多个植被的IE患者的ECHO预测因子与预后的关联。中重度反流的ECHO特征，起搏器导线的存在,左心室松弛受损，和升高的PASP和包括反复入院和设备移除在内的结局被发现与多个植被相关。
