Value of transthoracic echocardiography in predicting embolic events in active infective endocarditis. Duke Endocarditis Service.

Journal Article (Clinical Trial;Journal Article)

The purpose of this study was twofold: (1) to determine interobserver variability of echocardiographic characteristics of vegetations in patients with infective endocarditis, and (2) to assess the value of these vegetation characteristics in predicting embolic events. Although echocardiography contributes to the diagnosis of patients with infective endocarditis, its prognostic role in predicting embolic events is controversial. The echocardiograms of 41 patients with infective endocarditis were independently reviewed by 4 echocardiographers blinded to the clinical data. If a vegetation was present, the following characteristics were analyzed: involved site, size, mobility, shape, and pedunculated or sessile attachment. Each echocardiographer also made a "gestalt" estimate of embolic risk based on these vegetation characteristics. Interobserver agreement on vegetation characteristics and their relation to embolic events was then determined using kappa statistics and logistic regression analysis. Interobserver agreement was 98% with regard to echocardiographic vegetation presence and 97% with regard to the involved site. Of the 30 patients in whom vegetations were observed, complete observer agreement was achieved with regard to size in 22 (73%), mobility in 17 (57%), shape in 11 (37%), and attachment in 12 (40%). Vegetations with a maximal diameter of > 10 mm were associated with a 50% incidence of embolic events, compared with a 42% incidence of emboli in patients with vegetations measuring < or = 10 mm. Interobserver variability was great with respect to vegetation shape, mobility, and attachment characteristics. Echocardiographic vegetation characteristics were not helpful in defining the risk of embolic complications in patients with endocarditis.

Full Text

Duke Authors

Cited Authors

  • Heinle, S; Wilderman, N; Harrison, JK; Waugh, R; Bashore, T; Nicely, LM; Durack, D; Kisslo, J

Published Date

  • October 15, 1994

Published In

Volume / Issue

  • 74 / 8

Start / End Page

  • 799 - 801

PubMed ID

  • 7942553

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/0002-9149(94)90438-3


  • eng

Conference Location

  • United States