Br Heart J 1985; 53: 310-3 Vegetations in infective endocarditis Clinical relevance and diagnosis by cross sectional echocardiography WAYNE J STAFFORD,* JOAN PETCH, DOROTHY J RADFORD From the Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia SUMMARY Cross sectional echocardiography identified vegetations in 45 of 62 (73%) patients who had clinical evidence of active infective endocarditis. The sensitivity of this technique in diagnosing vegetations in infective endocarditis was 93% and the specificity 89%. The predictive value of a positive test was 96% and that of a negative test 800/o. Vegetations were detected with a similar frequency on the aortic and mitral valves. The incidence of valvar incompetence, congestive heart failure, and the need for surgical intervention was similar in the patients with and without vegeta- tions. Embolism occurred in 47/o of those patients with vegetations and in 12% of those without. The mortality rate was 27% in those with vegetations, and no patient without vegetations died. Thus cross sectional echocardiography is accurate in diagnosing vegetations in patients with infective endocarditis, and this finding identifies patients at high risk of embolic complications and death. Some patients with infective endocarditis have vegeta- tions which may be identified by echocardiography, and this finding has been suggested to indicate a poor prognosis with a high incidence of complications.I -3 Initial studies were, however, performed using M mode echocardiography,I-3 and this is less sensitive than cross sectional echocardiography in detecting smaller or anatomically less accessible vegetations.46 Few studies have been carried out that reassess the clinical significance of vegetations detected by wide angle cross sectional rediocardiography,25 and the surgical implications of this finding therefore remain controversial. The reliability of detecting vegetations by cross sectional echocardiography also requires careful assessment, as the differentiation of vegeta- tions from other valvar abnormalities by M mode echocardiography is difficult.8 In this study we attempted to solve these problems firstly by reviewing our experience of the accuracy of diagnosis of vegeta- Requests for reprints to Dr Dorothy J Radford, Deparment of Car- diology, The Prince Charles Hospital, Chermside, Queensland, Australia 4032. *Present address: Division of Cardiology, University of Miami, School of Medicine (D-39), PO Box 016960, Miami, Florida 33101, USA. Accepted for publication 14 November 1984 tions by cross sectional echocardiography, and, sec- ondly, by determining the relation between the pres- ence of vegetations and the occurrence of clinical complications in patients with active infective endocarditis. Patients and methods Sixty two consecutive patients (42 male, 20 female; mean age 43-8 (range 3-81) years) with the clinical evidence of infective endocarditis underwent cross sectional and M mode echocardiography between December 1979 and May 1983. Follow up was for a mean of 17 (range 1-42) months. All patients had strong clinical evidence of active endocarditis, includ- ing two or more of the following features: fever, sweating, heart murmur, splenomegaly, peripheral features of endocarditis, and positive blood cultures. All echocardiographic studies were performed in the standard views during the period of diagnosis and treatment in hospital using a Varian V-3000 (Varian Associates) phased array ultrasonograph. Vegetations were defined as masses, sessile or pedunculated, attached to the cardiac valves or endocardial sur- faces.9 The clinical records and echocardiographs were reviewed retrospectively and the accuracy of the diag- 310 on June 19, 2020 by guest. Protected by copyright. http://heart.bmj.com/ Br Heart J: first published as 10.1136/hrt.53.3.310 on 1 March 1985. Downloaded from