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Large vegetation size confers poor outcomes in infective endocarditis
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Among patients with infective endocarditis, a vegetation size of greater than 10 mm was associated with higher likelihood of embolism and mortality, according to a meta-analysis.
Researchers analyzed 6,646 adult patients with infective endocarditis from 21 studies published between 1983 and 2016 evaluating the association between vegetation size greater than 10 mm and embolic events. In the cohort, there were 5,116 vegetations with available dimensions.
Divyanshu Mohananey, MD, from the Heart and Vascular Institute at Cleveland Clinic, and colleagues determined that patients with vegetation size greater than 10 mm had greater odds of embolic events (risk difference, 0.13; 95% CI, 0.09-0.18; OR = 2.28; 95% CI, 1.71-3.05) and mortality (risk difference, 0.08; 95% CI, 0.02-0.13; OR = 1.63; 95% CI, 1.13-2.35) compared with patients with vegetation size less than 10 mm.
Risk for embolic events was comparable between patients with vegetation size less than 10 mm and patients with vegetation size greater than 10 mm in studies published between 1983 and 1999 (OR = 1.41; 95% CI, 0.79-2.53), but in studies published between 2000 and 2016, there was a much greater likelihood of vegetation size greater than 10 mm conferring elevated risk for embolic events (OR = 2.7; 95% CI, 1.91-3.81). However, the interaction between earlier and later studies was not statistically significant, according to the researchers.
The relationship between vegetation size and outcomes was not affected by age, sex or type of valve involved.
“Understanding the risk of embolization will allow clinicians to adequately risk-stratify patients and will also help facilitate discussions regarding surgery in patients with a vegetation size greater than 10 mm,” Mohananey and colleagues wrote. – by Erik Swain
Disclosure: One author reports he is a consultant for Myocardia.
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