Abstract
BackgroundInfective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results.MethodsMedical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018.ResultsA total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of “definite cases” before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (< 10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors.ConclusionsUnder some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.
Highlights
Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early
Difference between the surgery and non-surgery groups A total of 300 patients were consecutively diagnosed with native valvular endocarditis, and 182 underwent surgery
The surgery group was more likely to suffer from previous cardiovascular conditions or cardiac diseases (85% vs. 41%, odds ratio [Odd ratio (OR)] = 0.488, 95% confidence interval [Confidence interval (CI)]: 0.301–0.786) and more likely to present as heart murmurs (89.0% vs. 76.5%, OR = 2.403, CI: 1.277–4.525) and heart insufficiency (New York Heart Association class II to IV) (68.1% vs. 42.9%, OR = 2.809, CI: 1.739– 4.536) at admission
Summary
Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results. The sensitivities for the diagnosis of vegetations in native valves are 70% for TTE and 96% for TOE [6, 7]. Their identification may be difficult in IE patients with pre-existing valvular lesions like mitral valve prolapse, degenerative cardiac valve disease, prosthetic valves, small vegetations, recent embolization and in vegetation-negative endocarditis. Echocardiographic results must be interpreted with caution, synthesizing patient’s clinical features and their likelihood of IE
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