rerivalvular Abscesses due to Staphylococcus aureus Endocarditis Comparison with Streptococcus viridans Endocarditis and Incremental Value of Transesophageal Echocardiography
ORA THAI PACHIRAT, M.D.*, VIRAT KLUNGBOONKRONG, M.D., F.A.C.C. *
Affiliation : * Division of Cardiovascular Disease and Internal Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand. t Presented in part at the 48 th Annual Scientific Sessions of the American College of Cardiology. New Orleans. Louisiana, USA, March 7-10, 1999.
Method : Among 243 consecutive episodes of IE diagnosed using the Duke criteria, who underwent either transthoracic (TIE) or transesophageal echocardiography (TEE) at the Mayo Clinic between 1988 and 1993, there were 64 cases of SV and 61 of SA IE. Comparison of TTE and TEE detection of abscesses were restricted to patients with either surgical or autopsy exami- nation and both TTE and TEE were performed.
Results : Prosthetic valve and valve repair were significantly higher in SA compared to SV IE (46 vs 23%, P = 0.008). The prevalence of abscesses was higher in SA compared to SV IE (42 vs 14%, P = 0.08). I (10%) of abscess detected by TTE in SA compared to I (50%) in SV IE and 6 (60%) by TEE in SA and I (50%) in SV IE. Incremental value of TEE vs TIE was higher in SA 5/24 (21%) than in SV IE 0114 (0%) P = 0.067. Hospital mortality was significantly higher in SA than SV IE (13 vs 2%, P = 0.013)
Conclusion : Patients diagnosed with IE and those with SA I) presented more often with prosthetic valve IE, 2) developed more perivalvular abscesses, and 3) had a higher in hospital mortality than those with SV. Incremental value of TEE was higher in SA than in SV IE, 4) therefore, had a stringent requirement for initial and repeated TEE to detect this ominous complication of IE.
Keywords : Infective Endocarditis, Staphylococcus aureus Endocarditis, Streptococcus viridans Endocarditis, Transesophageal Echocardiography
