Early transthoracic echocardiography has useful prognostic value in left-sided native valve endocarditis despite limited diagnostic performance

George S. Heriot, Andrew Newcomb, Jonathan Darby, Andrew Wilson, Steven Y.C. Tong, Allen C. Cheng, Danny Liew

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    To investigate the prognostic implications of findings on early transthoracic echocardiography (TTE) in patients with definite left-sided native valve infective endocarditis (LNVIE). We reviewed a 10-year retrospective cohort of consecutive patients with definite LNVIE treated at a tertiary cardiothoracic centre. TTE studies performed within the first seven days of the index blood culture (for culture-positive cases) or hospital admission (for culture-negative cases) were reviewed for the presence of valvular vegetations, perivalvular abscesses, aortic or mitral regurgitation of moderate or greater severity or a bicuspid aortic valve. Six-week outcomes included all-cause mortality, cardiac surgery for endocarditis or new embolic cerebral infarction. Early TTE was performed in 118 of 151 episodes of definite LNVIE at a median of two days after the index blood culture or hospital admission. Findings on these studies included valvular vegetations or abscesses in 74 patients, moderate or severe aortic or mitral regurgitation in 67 patients and a bicuspid aortic valve in 19 patients. The presence of any of these findings conferred a relative risk of any adverse six-week outcome of 4.80 (95% confidence interval 1.6–17, p = 0.001). The presence of a bicuspid aortic valve appeared particularly predictive of the need for cardiac surgery, including for clinically occult paravalvular abscesses. Early TTE can be used to stratify patients with LNVIE by the risk of major endocarditis-related adverse outcomes occurring within the first six weeks of treatment.

    Original languageEnglish
    Pages (from-to)1569-1575
    Number of pages7
    JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
    Volume38
    Issue number8
    Early online date28 May 2019
    DOIs
    Publication statusPublished - Aug 2019

    Fingerprint

    Endocarditis
    Echocardiography
    Abscess
    Aortic Valve Insufficiency
    Mitral Valve Insufficiency
    Thoracic Surgery
    Cerebral Infarction
    Confidence Intervals
    Mortality
    Bicuspid Aortic Valve

    Cite this

    @article{11db4715f97b408ea481a2cf2b70cae9,
    title = "Early transthoracic echocardiography has useful prognostic value in left-sided native valve endocarditis despite limited diagnostic performance",
    abstract = "To investigate the prognostic implications of findings on early transthoracic echocardiography (TTE) in patients with definite left-sided native valve infective endocarditis (LNVIE). We reviewed a 10-year retrospective cohort of consecutive patients with definite LNVIE treated at a tertiary cardiothoracic centre. TTE studies performed within the first seven days of the index blood culture (for culture-positive cases) or hospital admission (for culture-negative cases) were reviewed for the presence of valvular vegetations, perivalvular abscesses, aortic or mitral regurgitation of moderate or greater severity or a bicuspid aortic valve. Six-week outcomes included all-cause mortality, cardiac surgery for endocarditis or new embolic cerebral infarction. Early TTE was performed in 118 of 151 episodes of definite LNVIE at a median of two days after the index blood culture or hospital admission. Findings on these studies included valvular vegetations or abscesses in 74 patients, moderate or severe aortic or mitral regurgitation in 67 patients and a bicuspid aortic valve in 19 patients. The presence of any of these findings conferred a relative risk of any adverse six-week outcome of 4.80 (95{\%} confidence interval 1.6–17, p = 0.001). The presence of a bicuspid aortic valve appeared particularly predictive of the need for cardiac surgery, including for clinically occult paravalvular abscesses. Early TTE can be used to stratify patients with LNVIE by the risk of major endocarditis-related adverse outcomes occurring within the first six weeks of treatment.",
    keywords = "Bacteremia, Diagnosis, Echocardiography, Endocarditis, Prognosis",
    author = "Heriot, {George S.} and Andrew Newcomb and Jonathan Darby and Andrew Wilson and Tong, {Steven Y.C.} and Cheng, {Allen C.} and Danny Liew",
    year = "2019",
    month = "8",
    doi = "10.1007/s10096-019-03589-w",
    language = "English",
    volume = "38",
    pages = "1569--1575",
    journal = "European Journal of Clinical Microbiology and Infectious Diseases",
    issn = "0934-9723",
    publisher = "Springer",
    number = "8",

    }

    Early transthoracic echocardiography has useful prognostic value in left-sided native valve endocarditis despite limited diagnostic performance. / Heriot, George S.; Newcomb, Andrew; Darby, Jonathan; Wilson, Andrew; Tong, Steven Y.C.; Cheng, Allen C.; Liew, Danny.

    In: European Journal of Clinical Microbiology and Infectious Diseases, Vol. 38, No. 8, 08.2019, p. 1569-1575.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Early transthoracic echocardiography has useful prognostic value in left-sided native valve endocarditis despite limited diagnostic performance

    AU - Heriot, George S.

    AU - Newcomb, Andrew

    AU - Darby, Jonathan

    AU - Wilson, Andrew

    AU - Tong, Steven Y.C.

    AU - Cheng, Allen C.

    AU - Liew, Danny

    PY - 2019/8

    Y1 - 2019/8

    N2 - To investigate the prognostic implications of findings on early transthoracic echocardiography (TTE) in patients with definite left-sided native valve infective endocarditis (LNVIE). We reviewed a 10-year retrospective cohort of consecutive patients with definite LNVIE treated at a tertiary cardiothoracic centre. TTE studies performed within the first seven days of the index blood culture (for culture-positive cases) or hospital admission (for culture-negative cases) were reviewed for the presence of valvular vegetations, perivalvular abscesses, aortic or mitral regurgitation of moderate or greater severity or a bicuspid aortic valve. Six-week outcomes included all-cause mortality, cardiac surgery for endocarditis or new embolic cerebral infarction. Early TTE was performed in 118 of 151 episodes of definite LNVIE at a median of two days after the index blood culture or hospital admission. Findings on these studies included valvular vegetations or abscesses in 74 patients, moderate or severe aortic or mitral regurgitation in 67 patients and a bicuspid aortic valve in 19 patients. The presence of any of these findings conferred a relative risk of any adverse six-week outcome of 4.80 (95% confidence interval 1.6–17, p = 0.001). The presence of a bicuspid aortic valve appeared particularly predictive of the need for cardiac surgery, including for clinically occult paravalvular abscesses. Early TTE can be used to stratify patients with LNVIE by the risk of major endocarditis-related adverse outcomes occurring within the first six weeks of treatment.

    AB - To investigate the prognostic implications of findings on early transthoracic echocardiography (TTE) in patients with definite left-sided native valve infective endocarditis (LNVIE). We reviewed a 10-year retrospective cohort of consecutive patients with definite LNVIE treated at a tertiary cardiothoracic centre. TTE studies performed within the first seven days of the index blood culture (for culture-positive cases) or hospital admission (for culture-negative cases) were reviewed for the presence of valvular vegetations, perivalvular abscesses, aortic or mitral regurgitation of moderate or greater severity or a bicuspid aortic valve. Six-week outcomes included all-cause mortality, cardiac surgery for endocarditis or new embolic cerebral infarction. Early TTE was performed in 118 of 151 episodes of definite LNVIE at a median of two days after the index blood culture or hospital admission. Findings on these studies included valvular vegetations or abscesses in 74 patients, moderate or severe aortic or mitral regurgitation in 67 patients and a bicuspid aortic valve in 19 patients. The presence of any of these findings conferred a relative risk of any adverse six-week outcome of 4.80 (95% confidence interval 1.6–17, p = 0.001). The presence of a bicuspid aortic valve appeared particularly predictive of the need for cardiac surgery, including for clinically occult paravalvular abscesses. Early TTE can be used to stratify patients with LNVIE by the risk of major endocarditis-related adverse outcomes occurring within the first six weeks of treatment.

    KW - Bacteremia

    KW - Diagnosis

    KW - Echocardiography

    KW - Endocarditis

    KW - Prognosis

    UR - http://www.scopus.com/inward/record.url?scp=85066470005&partnerID=8YFLogxK

    U2 - 10.1007/s10096-019-03589-w

    DO - 10.1007/s10096-019-03589-w

    M3 - Article

    VL - 38

    SP - 1569

    EP - 1575

    JO - European Journal of Clinical Microbiology and Infectious Diseases

    JF - European Journal of Clinical Microbiology and Infectious Diseases

    SN - 0934-9723

    IS - 8

    ER -