Sanfilippo et al developed a grading system and risk score for patients with infectious endocarditis based on echocardiographic findings. This can help identify a patient at increased risk for complications. The authors are from Massachusetts General Hospital in Boston.
Parameters seen on echocardiography:
(1) vegetation size
(2) vegetation mobility
(3) vegetation extent
(4) vegetation consistency (compared to myocardial echoes)
Size of vegetation:
(1) D1 is the maximal height of the vegetation perpendicular to the axis of the leaflet in mm
(2) D2 is the extent of the vegetation at the base parallel to the leaflet surface in mm
|
Parameter |
Finding |
Grade |
|
vegetation size (maximum of D1 and D2) |
<= 6 mm |
1 |
|
|
7 to 10 mm |
2 |
|
|
11 to 15 mm |
3 |
|
|
>= 16 mm |
4 |
|
vegetation mobility |
fixed with no detectable independent motion |
1 |
|
|
fixed base but mobile free edge, with base greater than height (D2 > D1) |
2 |
|
|
pedunculated with height greater than base (D2 < D1) |
3 |
|
|
prolapsing (crosses the coaptation plane of the leaflets at some point during the cardiac cycle |
4 |
|
vegetation extent |
single vegetation |
1 |
|
|
multiple vegetations limited to a single valve leaflet |
2 |
|
|
multiple valve leaflets involved |
3 |
|
|
extends into extravalvular structures |
4 |
|
vegetation consistency |
completely calcified |
1 |
|
|
partially calcified |
2 |
|
|
denser than myocardium but not calcified |
3 |
|
|
equal to myocardial echoes |
4 |
where:
• A consistency check should be done between vegetation size and mobility. A pedunculated or prolapsing vegetation should have a height greater than base.
echocardiographic score =
= (Grade of vegetation size) + (Grade of vegetation mobility) + (Grade of vegetation extent)
Interpretation:
• minimum score: 3
• maximum score: 12
• The higher the score the more likely the patient will have complications.
For mitral valve endocarditis (Figure 5, page 1196):
(1) A score <= 5 had a low risk for complications.
(2) A score 6 or 7 was associated with moderate risk of complications.
(3) A score >= 8 was associated with high risk for complications.
For aortic valve endocarditis (Figure 6, page 1197):
(1) A score <= 3 had a low risk for complications.
(2) A score 4 or 7 was associated with moderate risk of complications.
(3) A score >= 8 was associated with high risk for complications.
Specialty: Infectious Diseases, Cardiology
ICD-10: ,
