Abstract 323: Three-dimensional Transesophageal Echocardiography and Speckle Tracking Echocardiography in Infective Aortic Endocarditis: Analysis of Parameters Predictors of Outcome

Abstract

Purpose: Due to the high mortality and morbidity of patients with aortic endocarditis, careful monitoring is necessary to recognize an early failure of antibiotic and cardiokinetic therapy and avoid a possible cardiogenic or septic shock. The timing of surgery is crucial for patients in whom medical therapy fails. The aim of our study is to identify potential echocardiographic "markers" of adverse events in patients with aortic regurgitation from infective endocarditis. Methods: Seventeen patients with aortic regurgitation (AR) from infective endocarditis were studied by 3-dimensional transesophageal echocardiography (3D-TEE) and transthoracic speckle tracking echocardiography (STE). Fifteen healthy subjects were selected as controls. Vegetation size was assessed by 3D-TEE. Standard transthoracic echocardiographic parameters were determined. Global left ventricular (LV) longitudinal strain (LS), radial and circumferential strain were measured by STE. Averaged LV rotation and rotational velocities from the base and apex were obtained and used for calculation of LV torsion (LVtor). Results: Severe AR had decreased LS compared with control subjects. LVtor decreased significantly in severe AR compared to normals (p<.005) as a result of a predominant decrease in apical rotation. By multivariate analysis, LV-LS (p=0.005), LV-tor (p=0.006) and vegetation size (p=0.009) were predictive of adverse events. ROC curves suggested that thresholds offering an adequate compromise between sensitivity and specificity for adverse events detection were -18.2% for mean global LV-LS (AUC .79), 13mm for vegetation size (AUC .86), and 19.4degrees for LVtor (AUC .81). The combination of vegetation size and LV strain had the highest diagnostic accuracy for identifying adverse outcome, superior to vegetation size (p=.006) or LV strain alone (p=.002). Conclusions: The combined assessment of the characteristics of vegetating masses and LV function strain parameters improves the sensitivity of the echocardiographic indices in predicting cardiac morbidity and mortality of aortic regurgitation from infective endocarditis.