NEW YORK (Reuters Health) – Patients with infective endocarditis and a vegetation size greater than 10 mm are at significantly increased risk of embolism and death, according to a new meta-analysis.
“Infective endocarditis carries a high rate of mortality and embolic events and the disease is coming into much sharper focus right now because of the drug epidemic and shared needles, so we are seeing a substantial surge in endocarditis,” Dr. Milind Desai from the Heart and Vascular Institute at the Cleveland Clinic in Ohio said in a phone interview with Reuters Health.
The question is, “how can we better risk-stratify; is there a size threshold beyond which the risk of stroke or death increases,” he explained.
A vegetation size greater than 10 mm has been suggested as an optimal cutoff to estimate the risk of embolism, but the evidence is based largely on small observational studies. “The premise of our study was to collate the data in a meta-analysis after very rigorous quality control of the literature,” Dr. Desai said.
The researchers analyzed data from 21 unique studies including more than 6,500 unique patients with infective endocarditis and more than 5,000 measured vegetations.
They found that patients with a vegetation size topping 10 mm had significantly increased risks of embolic events (odds ratio, 2.28; P<0.001) and death (OR, 1.63; P=0.009) compared to patients with a smaller vegetation size.
The association did not depend on age, sex, or type of valve involvement, and the strength of association of a vegetation size greater than 10 mm with embolic outcomes increased over time.
“The bottom line is that on echocardiography if you have 10 mm or larger vegetation lesion, you are at a much higher risk for stroke or other embolic events and death. Patients with these large lesions may be better off being managed aggressively because of their higher risk and ideally sent to an experienced center,” Dr. Desai said.
SOURCE: http://bit.ly/2GyVAtu
JAMA Intern Med 2018.
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