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Evaluation of vegetation size and its relationship with septic pulmonary embolism in tricuspid valve infective endocarditis: A real time 3 DTEE study
Author(s) -
Utsunomiya Hiroto,
Berdejo Javier,
Kobayashi Sayuki,
Mihara Hirotsugu,
Itabashi Yuji,
Shiota Takahiro
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13482
Subject(s) - infective endocarditis , medicine , confidence interval , vegetation (pathology) , endocarditis , pulmonary embolism , odds ratio , tricuspid valve , pulmonary artery , cardiology , pulmonary valve , pathology
Background Tricuspid valve infective endocarditis ( TVIE ) causes septic pulmonary embolism ( PE ). However, the impact of vegetation size on PE is not fully elucidated. Methods In 26 consecutive patients with definite TVIE according to Duke criteria, we tested clinical, microbiological, and echocardiographic data including real time three‐dimensional transesophageal echocardiography (3 DTEE ) as potential predictors of PE . 3 DTEE measurement of maximum length of vegetation ( MLV ) was obtained with Advanced QLAB Quantification Software by cropping the 3D volume with the appropriate 2D plane to obtain the largest value. The standard two‐dimensional transesophageal echocardiography (2 DTEE ) images were also evaluated to determine the MLV . Results Pulmonary embolism occurred after TVIE diagnosis with 3 DTEE assessment and initiation of antibiotic therapy in 12 patients (46.2%). The 3 DTEE MLV was larger than the 2 DTEE value with a mean difference of 3.6 mm (95% CI , 2.5–4.6 mm). The best cutoff value for prediction of PE was MLV ≥16.4 mm with 3 DTEE and MLV ≥9.5 mm with 2 DTEE . The positive predictive value increased from 76.9% to 90% when 3 DTEE was used. The accuracy of classification of patients with PE increased from 80.6% to 84.9% with 3 DTEE . On multivariate analysis, 3 DTEE MLV ≥16.4 mm (odds ratio 20.5; 95% confidence interval 1.31–322; P =.031) was independently associated with the occurrence of PE after adjustment for age, sex, complex vegetation, and the number of vegetation‐attached leaflets. Conclusions In TVIE , vegetation length is a strong predictor of the occurrence of PE . In combination with 2 DTEE , 3 DTEE may identify high‐risk patients who will need a more aggressive therapeutic strategy.