3D echocardiographic characteristic of embolism and in-hospital mortality in patients with infective endocarditis / 中国医学影像技术

ABSTRACT

Objective To assess the echocardiographic characteristics of embolism and in-hospital mortality in patients with infective endocarditis using three-dimensional transesophageal echocardiography (3D TEE).Methods Retrospective review of 124 patients with native valve infective endocarditis was performed to examine its characteristics by two-dimensional transthoracic echocardiography (2D TTE),multi-plane and 3D TEE.The primary endpoint was embolism and mortality that occurred within one month before or after operation.The combined simple score was calculated by assigning 1 point each for the presence of large vegetation,abscess or fistula,rupture of valvular chord,moderated or severe valvular regurgitation and perforation or serious valvular destruction.Hosmer and area under the curve was calculated to predict embolism and adverse events with the combined simple score,length of vegetation,serious valvular destruction with abnormal morphology.Results In 124 patients,embolic events occured in 27 cases (27/124,21.77％).Multi-plane and 3D TEE can identify the exact location and length of vegetation compared with 2D TTE,which miss-diagnosed vegetation in left atrium and papillary muscle.The clinical presentation of embolism patients was remarkable for lower hemoglobin level (P＜0.05).The ratio of multi-located vegetation,mortality and serious valvular destruction with abnormal morphology were higher in embolism and adverse events patients than those in non-embolism and adverse events patients (all P＜0.05).The area under the curve of combined simple score,lengh of vegetation for embolisms and adverse events and serious valve destruction with abnormal morphology for embolism and adverse events were 0.65 (P=0.06),0.60 (P=0.19)) and 0.70 (P=0.03).Conclusion Multi-plan and 3D TEE plays a key role in the diagnosis of patients with infecitive endocarditis,especially vegetations in occasional location.Serious valve destruction with abnormal morphology is associated with embolism and adverse events.