Published Online
on June 27, 2005

A more recent version of this article appeared on July 5, 2005

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Submitted on February 14, 2004
Revised on February 12, 2005
Accepted on March 11, 2005

Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography. A Prospective Multicenter Study

Franck Thuny MD, Giovanni Disalvo MD, Olivier Belliard MD, Jean-François Avierinos MD, Valeria Pergola MD, Valerie Rosenberg MD, Jean-Paul Casalta MD, Joanny Gouvernet MD, PhD, Geneviève Derumeaux MD, Diana Iarussi MD, Pierre Ambrosi MD, Raffaello Calabro MD, Alberto Riberi MD, Frédéric Collart MD, Dominique Metras MD, Hubert Lepidi MD, Didier Raoult MD, PhD, Jean-Robert Harle MD, Pierre-Jean Weiller MD, Ariel Cohen MD, and Gilbert Habib MD^*

From the Departments of Cardiology of La Timone Hospital, Marseille, France (F.T., J.A., J.C., J.G., P.A., A.R., F.C., D.M., H.L., D.R., J.H., P.W., G.H.); Saint-Antoine Hospital, Paris, France (O.B., V.R., A.C.); Charles Nicolle Hospital, Rouen, France (G. Derumeaux); and Second University, Naples, Italy (G. Disalvo, V.P., D.I., R.C.).

^* To whom correspondence should be addressed. E-mail: gilbert.habib{at}ap-hm.fr.

Background--The incidence of embolic events (EE) and death is still high in patients with infective endocarditis (IE), and data about predictors of these 2 major complications are conflicting. Moreover, the exact role of echocardiography in risk stratification is not well defined.

Methods and Results--In a multicenter prospective European study, including 384 consecutive patients (aged 57±17 years) with definite IE according to Duke University criteria, we tested clinical, microbiological, and echocardiographic data as potential predictors of EE and 1-year mortality. Transesophageal echocardiography was performed in all patients. Embolism occurred before or after IE diagnosis (total-EE) in 131 patients (34.1%) and after initiation of antibiotic therapy (new-EE) in 28 patients (7.3%). Staphylococcus aureus and Streptococcus bovis were independently associated with total-EE, whereas vegetation length >10 mm and severe vegetation mobility were predictors of new-EE, even after adjustment for S aureus and S bovis. One-year mortality was 20.6%. In multivariable analysis, independently of the other predictors of death (age, female sex, creatinine serum >2 mg/L, moderate or severe congestive heart failure, and S aureus) and comorbidity, vegetation length >15 mm was a predictor of 1-year mortality (adjusted relative risk=1.8; 95% CI, 1.10 to 2.82; P=0.02).

Conclusions--In IE, vegetation length is a strong predictor of new-EE and mortality. In combination with clinical and microbiological findings, echocardiography may identify high-risk patients who will need a more aggressive therapeutic strategy.

Key words: echocardiography • embolism • endocardium • prognosis

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