Echocardiographic predictors and associated outcomes of multiple vegetations in infective endocarditis: A pilot study

Table 1 Baseline demographic parameters of the patients with multiple vegetation as compared to single vegetation

Variable	Multiple vegetations (N = 23)	Single vegetation (N = 44)	OR	P value
Gender, n (%)			1	0.98
Female	10 (43.5)	19 (43)
Male	13 (56.5)	25 (57)
Mean age (SD)	50 (20.6)	45 (18.6)	1.01	0.33
Prior IE, n (%)	8 (35)	14 (32)	1.1	0.8
Native valve IE, n (%)	18 (78)	37 (84)	0.68	0.55
TTE (N = 49), n (%)	11 (48)	20 (45)	0.91	0.8
TEE (N = 49), n (%)	18 (78)	30 (68)	1.6	0.54
HR (SD)	105 (18.5)	106 (21.8)	0.99	0.83
LAVI (SD)	32 (11.7)	30 (10.5)	1.01	0.50
PASP (SD)	38 (14.2)	32.5 (10.9)	1.03	0.10

SD: Standard deviation; IE: Infective endocarditis; TTE: Trans thoracic echocardiogram; TEE: Transesophageal echocardiogram; HR: Heart rate; LAVI: Left atrial volume index; PASP: Pulmonary artery systolic pressure; OR: Odds ratio.

Table 2 Baseline echocardiographic parameters of the patients with multiple vegetation as compared to single vegetation, n (%)

ECHO variable	Multiple vegetations (N = 23)	Single vegetation (N = 44)	OR	P value
Valvular abnormality	2 (9)	6 (14)	0.603	0.5
Moderate to severe regurgitation	19 (83)	24 (55)	4	0.028a
Prosthetic valve	6 (26)	7 (16)	1.9	0.32
Pacemaker lead	6 (26)	3 (7)	4.8	0.039a
Indwelling catheter	3 (13)	10 (23)	0.5	0.34
Low EF (EF < 50)	2 (9)	6 (14)	0.6	0.55
RAE	8 (35)	13 (29.5)	1.3	0.66
LAE	8 (35)	15 (34)	1	0.95
Impaired LV relaxation	19 (83)	24 (55)	4	0.028a
Elevated PASP	11 (48)	13 (29.5)	2.2	0.1

^aP < 0.05.

ECHO: Echocardiographic; OR: Odds ratio; EF: Ejection fraction; RAE: Right atrial enlargement; LAE: Left atrial enlargement; LV: Left ventricle; PASP: Pulmonary artery systolic pressure.

Table 3 Outcome of the patients with multiple vegetation as compared to single vegetation, n (%)

Outcomes	Multiple vegetations (N = 23)	Single vegetation (N = 44)	OR	P value
Prolonged antibiotics	7 (30)	9 (20.5)	1.7	0.36
Recurrent bacteremia	11 (48)	12 (27)	2.4	0.09
Recurrent admission	15 (65)	15 (34)	3.6	0.017a
Embolic phenomenon	9 (39)	9 (20.5)	2.5	0.1
Hypotension	8 (35)	9 (20.5)	2.1	0.2
ICU stay	11 (48)	11	2.8	0.06
MV	5 (22)	7 (16)	1.5	0.55
Removal of device	6 (26)	3 (7)	4.8	0.039a
Surgical intervention	8 (35)	7 (16)	2.8	0.08
Mortality	1 (4)	3 (7)	0.6	0.68

^aP < 0.05.

OR: Odds ratio; ICU: Intensive care unit; MV: Mechanical ventilation.

Table 4 Echocardiographic predictors of outcome in infective endocarditis

Finding	Embolism	Morbidity	Mortality
Vegetation size1	+	+	+
Mitral valve location	+	+	+
Anterior leaflet of MV	+	-	-
Vegetation mobility2	+	-	-
Multiple vegetation	+	+	-
Cardiac device vegetations	+	+	+
Valvular complications3	+	+	+
Perivalvular complications4	+	+	+
Prosthetic valve vegetation	+	+	+
Prosthetic valve dehiscence	+	+	+

¹Size of 10 mm.

²> 60° of displacement angle.

³Flail leaflet, leaflet perforation, acute valvular regurgitation, valvular obstruction.

⁴Abscess, aneurysm, fistula, paravalvular regurgitation.

MV: Mechanical ventilation.