Correlation of vegetation morphology to clinical presentation in infective endocarditis patients

Purpose: The aim of the study was to correlate the clinical presentation and ecnocardiographic features -especially vegetations (VG)- in pts with infective endocarditis (IE). Methods: Fifty pts with native valve (NV) IE and 7 pts with prosthetic valve (PV) IE were studied. IE was diagnosed depending on the presence of +ive culture in 41/57 (72%), VG in 43/50 (86%), or 5 clinically suggestive features. Clinical features were: fever in 53 pts (93%), clubbing in 9(16%), petechiae in 18 (32%), splinter hges in 3 (5%) Janeway lesions in 2 (3.5%), Oslers nodes in 3 (5%), retinal hges in 10 (17%), Roth's spots in 2 (3.5%), splenomegaly in 22 (39%), new murmur in 4 (7%), changing murmur in 6 (10%). Anemia Hg < 11 g in 48 (84%), hematuria in 34 (60%). Results: The size of VG ranged from 53 mm2 to 487 mm2. The sessile VG were 37 while the pedunculated were 28 VG. VG size was affected by the duration of IE, the VG size >200 mm2 was present in 2 pts with duration < 2m, and in 21 pts with duration >2m The VG size was affected by the microorganism, with Str viridans the average size was 221 mm2, with Str pyogenes it was 189, with Staph aureus 309. Followup of VG size with 2D echo for NV IE demonstrated no change in 11 pts (26%), decrease in 14 (33%), and increase in 12 (28%). The decrease in size correlated with embolization in 9 pts. No correlation was found between change in size and success of treatment. After 6 m. followup 58% of pts survived. Pts without VG had better survival but the difference was statistically insignificant. Conclusions: The diagnostic and prognostic value of VG in IE was demonstrated.