Di Salvo et al identified risk factors for embolic events in patients with infective endocarditis. These can help to identify a patient who should undergo surgery. The authors are from La Timone Hospital in Marseille.
Patient selection: infective endocarditis
Outcome: embolic event (CNS, GI, other)
Evaluation: transesophageal echocardiography (TEE)
Parameters:
(1) mobility of the vegatation
(2) length of vegetation
Vegetation Mobility (Sanfilippo et al)
Descriptor
fixed with no detectable independent motion
absent
fixed based with mobile free edge
low
pedunculated, stays within the same chamber during the cardiac cycle
moderate
prolapsing, cross the coaptation plane of the valve leaflets during the cardiac cycle
severe
Length of Vegetation
Descriptor
very small
absent
< 10 mm
small
10 to 15 mm
moderate
> 15 mm
large
The risk for an embolic event was very high for vegetations > 15 mm AND with severe mobility.
One way of capturing this information is the following table (not in references)
Parameter
Finding
Points
mobility
absent or low
0
moderate
1
severe
2
length of vegetation
< 10 mm
0
10 to 15 mm
1
> 15 mm
2
total risk score =
= SUM(points for the 2 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the greater the risk for embolic events.
• The risk for a score of 4 is very high.
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