Background
Methods
Diagnostic criteria
Study sample
Statistical analyses
Results
Difference between the surgery and non-surgery groups
Variable | Total N = 300 | Surgery N = 182 | None surgery N = 118 | P |
---|---|---|---|---|
Previous cardiovascular conditions or cardiac diseases | 126 (42.0) | 85 (46.7) | 41 (34.5) | 0.003 |
Degenerative calcific valvular disease | 27 (9.0) | 18 (9.9) | 9 (7.6) | 0.606 |
Rheumatic heart disease | 59 (19.7) | 41 (22.5) | 18 (15.1) | 0.122 |
Congenital heart disease | 58 (19.3) | 42 (23.1) | 16 (13.4) | 0.053 |
Clinical features | ||||
Fever | 251 (83.7) | 141 (77.5) | 110 (92.4) | 0.000 |
Heart murmurs | 253 (84.3) | 162 (89.0) | 91 (76.5) | 0.006 |
Ischemic stroke | 65 (21.7) | 31 (17.0) | 34 (28.6) | 0.016 |
Hemorrhagic stroke | 26 (8.7) | 10 (5.5) | 16 (13.4) | 0.015 |
Heart insufficiency (NYHA II ~ IV) | 175 (58.3) | 124 (68.1) | 51 (42.9) | 0.000 |
bAcute congestive heart failure | 64 (21.3) | 41 (22.5) | 23 (19.3) | 0.531 |
Positive blood culture | 172 (57.3) | 93 (51.1) | 79 (66.4) | 0.007 |
Staphylococcus aureus | 43 (14.3) | 14 (7.7) | 29 (24.4) | 0.000 |
Modified Duke’s criteria | ||||
Definite IE | 166 (55.3) | 81 (44.5) | 85 (71.4) | 0.000 |
Suspected IE | 113 (37.7) | 80 (44.0) | 33 (27.7) | 0.005 |
Excluded | – | a21 (11.5) | – | – |
Pathological criteria | ||||
Pathological confirmed | – | a173 (95.1) | – | – |
Pathological excluded | – | a9 (4.9) | – | – |
In-hospital death | 32 (10.7) | 8 (4.4) | 24 (20.2) | 0.000 |
Variable | Total N = 300 | Surgery N = 182 | None surgery N = 118 | P |
---|---|---|---|---|
Positive echocardiographic results | ||||
Vegetation | 266 (88.7) | 157 (86.3) | 109 (91.6) | 0.103 |
Left heart | 193 (64.3) | 117 (64.3) | 76 (63.9) | 0.983 |
Only on aortic valve | 70 (23.3) | 42 (23.1) | 28 (23.5) | 0.896 |
Only on mitral valve | 101 (33.7) | 57 (31.3) | 44 (37.0) | 0.285 |
Aortic valve and mitral valve | 22 (7.3) | 18 (9.9) | 4 (3.4) | 0.035 |
Right heart | 58 (19.3) | 32 (17.6) | 26 (21.8) | 0.340 |
Only on tricuspid valve | 54 (18.0) | 29 (15.9) | 25 (21.0) | 0.247 |
Only on pulmonic valve | 4 (1.3) | 3 (1.6) | 1 (0.8) | 0.940 |
Left heart and right heart | 9 (3.0) | 2 (1.1) | 7 (5.9) | 0.040 |
Perivalvular abscess | 4 (1.3) | 3 (1.6) | 1 (0.8) | 0.940 |
Aortic sinus aneurysm | 6 (2.0) | 4 (2.2) | 2 (1.7) | 1.000 |
Perforation | 20 (6.7) | 11 (6.0) | 9 (7.6) | 0.591 |
Severe valve insufficiency | 176 (58.7) | 122 (67.0) | 54 (45.4) | 0.000 |
Size of vegetations | ||||
> 1 cm | 236 (78.7) | 144 (79.1) | 92 (77.3) | 0.811 |
Pathological and echocardiographic results in the surgery group
Pathology | Echocardiography | McNemar test | |
---|---|---|---|
P | |||
Perivalvular abscess | 13 (7.1) | 3 (1.6) | 0.013 |
Perforation | 25 (13.7) | 11 (6.0) | 0.013 |
Aortic sinus aneurysm | 4 (2.2) | 4 (2.2) | 1.000 |
Vegetation | 173 (95.1) | 157 (86.3) | 0.007 |
Left heart | 129 (70.9) | 117 (64.3) | 0.050 |
Aortic valve | 40 (22.0) | 42 (23.1) | 0.832 |
Mitral valve | 63 (34.6) | 57 (31.3) | 0.180 |
Aortic valve and mitral valve | 26 (14.3) | 18 (9.9) | 0.039 |
Right heart | 33 (18.1) | 32 (17.6) | 1.000 |
Tricuspid valve | 27 (14.8) | 29 (15.9) | 0.687 |
Pulmonic valve | 6 (3.3) | 3 (1.6) | 0.250 |
Left heart and right heart | 6 (3.3) | 2 (1.1) | 0.219 |
aAbnormal cardiac structure | 12 (6.6) | 8 (4.4) | 0.388 |
Factors related to the false-negative TTE results
Variable | Category | Number | Inconsistence(%) | Univariate analysis | Multivariate analysis | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
P | OR | 95%CI | P | OR | 95%CI | ||||||
lower | upper | lower | upper | ||||||||
Previous cardiovascular conditions or cardiac diseases | |||||||||||
Congenital heart disease | yes | 42 | 11 (26.2) | 0.008 | 3.194 | 1.322 | 7.715 | 0.038 | 2.907 | 1.062 | 7.956 |
no | 140 | 14 (10.0) | |||||||||
Degenerative cardiac valve disease | yes | 18 | 3 (16.7) | 0.984 | 1.291 | 0.645 | 4.825 | ||||
no | 164 | 22 (13.4) | |||||||||
Rheumatic heart disease | yes | 41 | 9 (22.0) | 0.083 | 2.197 | 0.890 | 5.428 | 0.080 | |||
no | 141 | 16 (11.3) | |||||||||
Clinical features | |||||||||||
Fever | yes | 141 | 15 (10.6) | 0.024 | 0.369 | 0.151 | 0.900 | 0.028 | 0.309 | 0.108 | 0.882 |
no | 41 | 10 (24.4) | |||||||||
Heart murmurs | yes | 162 | 18 (11.1) | 0.010 | 0.232 | 0.082 | 0.658 | 0.003 | 0.165 | 0.050 | 0.546 |
no | 20 | 7 (35.0) | |||||||||
Embolism | yes | 40 | 8 (20.0) | 0.193 | 1.838 | 0.728 | 4.639 | ||||
no | 142 | 17 (12.0) | |||||||||
Positive blood culture results | yes | 94 | 10 (10.6) | 0.21 | 0.579 | 0.245 | 1.368 | ||||
no | 88 | 15 (17.0) | |||||||||
Size of vegetations | < 1 cm | 32 | 12 (37.5) | 0.000 | 6.330 | 2.532 | 15.873 | 0.000 | 8.197 | 2.841 | 23.256 |
> 1 cm | 150 | 13 (8.7) |