Abstract 19888: Diagnostic Accuracy of Modern-era Echocardiography for Detection of Surgical Complications of Left-sided Infective Endocarditis
Aim: To contribute contemporary data to the limited number of studies in the literature comparing modern-era echocardiography directly with surgical findings for accurately detecting the broad range of serious intra-cardiac complications of left-sided infective endocarditis (IE).
Methods: Retrospective analysis of all patients who underwent surgery for complicated IE at the Prince Charles Hospital, Brisbane, Australia and the John Ochsner Heart and Vascular Institute, New Orleans, USA between 2007-2012 inclusive. Data collected included echocardiography and surgical reports, microbiology, and patient risk factors.
Results: There were 156 subjects (106 [67.9%] male, age [51.98 +/- 16.2 years]) who required cardiac surgery for complicated IE. The most common predisposing factors were: mechanical valve prosthesis (18.6%), intravenous drug abuse (17.3%), bioprosthetic valve (15.4%) and degenerative valve disease (12.2%) with 13.4% of patients having ≥ 3 risk factors. Causative organisms included Staphylococcus sp. (37.3%), followed by Streptococcus sp. (31.4%), Gram-negative spp. (5.1%) and Fungal spp. (0.8%). The median time between TTE/TEE and surgery was 2.00+/-1.61 days and 1.63+/-5.71 days, respectively. LV function was assessed: EF ≥55% (77.1%), EF 45-54%(15.0%), EF 30-44% (6.5%) and EF <30% (1.3%). Average grade of regurgitation for infected valves: Native AV (Gr 3/4 AR), Native MV (Gr 3/4 MR), Prosthetic AV (Gr 2/4 AR) and Prosthetic MV (Gr 1/4 MR). Echo sensitivity, specificity, type of valve and number of complications are shown in the table.
Conclusion: Modern-era TTE imaging has made significant improvements in diagnostic accuracy when compared with older published studies. Although TTE is shown to be generally highly sensitive for identification of vegetations in this cohort, TEE remains the superior echo modality for complicated IE.
Author Disclosures: J.F. Sedgwick: None. A. Maurice: None. J. Tafur: None. S. Oleck: None. A. Khan: None. K. Phan: None. Y. Tsai: None. M. West: None. D.J. Burstow: None. Y. Gilliland: None.
- © 2014 by American Heart Association, Inc.