The ability of vegetation size on echocardiography to predict clinical complications: A meta-analysis☆,☆☆,★
Section snippets
Methods
Studies were identified by means of a computerized literature search (MEDLINE) using the key words infective endocarditis and echocardiography. The computerized search was supplemented by a manual review of references cited in the bibliographies of these studies. Studies were limited to English-language works and excluded case reports and abstracts. Because tricuspid valve endocarditis is most often associated with intravenous drug use and is generally caused by Staphylococcus aureus, studies
Results
Does vegetation size >10 mm increase the risk of systemic embolization? Ten studies enrolling a total of 738 patients were included in the analysis (Figure 1).**Individually, four of the studies demonstrated a significantly increased risk for
Discussion
There has been considerable debate regarding the significance of vegetation size in patients with infective endocarditis. While some investigators have failed to detect significant correlations between vegetation size and frequency of complications,16 others have found vegetation size to be an important correlate of clinical outcomes.5, 9 Much of the discrepancy is likely related to the small sample sizes in several of these studies and the attendant problem of low statistical power to detect
Conclusions
This analysis supports the hypothesis that echocardiographically detected left-sided vegetations >10 mm pose a significantly increased risk of (1) systemic embolism and (2) need for valve-replacement surgery than cases where either no or smaller vegetations are detected. A similar effect on mortality was not detected, although the pooled number of fatal outcomes was small. While this analysis supports the assertion that vegetation size is an important determinant of systemic embolization, there
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Vegetation Size in Patients with Infective Endocarditis: Does Size Matter?
2022, Journal of the American Society of EchocardiographyNeurologic complications of infective endocarditis
2022, Infective Endocarditis: A Multidisciplinary ApproachRisk of stroke subsequent to infective endocarditis: A nationwide study
2019, American Heart JournalInfective endocarditis: Surgical management and prognostic predictors
2018, Revista Portuguesa de CardiologiaCitation Excerpt :Embolic events are a life-threatening complication. Predictors of cerebral embolism have been identified in previous studies and include size and mobility of vegetations, causal microorganism and the affected valve.23–25 Our study identified mitral valve IE as an independent predictor of embolism.
Which patients with infective endocarditis require emergency surgery?
2016, Presse MedicaleEndocarditis: The Role of Echocardiography in Diagnosis and Clinical Decision-Making
2016, Practice of Clinical Echocardiography
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From the Cardiology Unit, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington.
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Reprint requests: Marc D. Tischler, MD, Director, Cardiac Ultrasound Laboratory, Cardiology Unit, McClure 1, Medical Center Hospital of Vermont, Burlington, VT 05401.
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