经胸与经食管超声心动图测量感染性心内膜炎患者植被长度对手术指征的影响

ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy Pub Date : 2020-07-01 DOI:10.1136/HEARTJNL-2020-BCS.11

D. Hoare, S. Bhattacharyya, G. Lloyd, W. Young, S. Woldman

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Vegetation length was measured on two dimensional images. Indications for surgery to prevent embolism using the ESC 2015 guidelines were compared for vegetation length on TOE and TTE. Results The median time between TTE and TOE was 2 days. 21/68 (30.8%) patients with vegetations identified on TOE were not identified on TTE. Of the remaining 47 patients, 27 (57.4%) had longer vegetations measured on TOE than on TTE with the mean difference being 7.8mm. 2/47 (4.3%) patients had the same vegetation length on TOE as on TTE. 18/47 (38.3%) patients had longer vegetations measured on TTE than on TOE with the mean difference being 4.3mm. The mean difference in vegetation length overall was 5.9mm. 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引用次数: 0

摘要

感染性心内膜炎(IE)死亡率高。较长的植被长度与中风风险和死亡率增加有关。手术预防栓塞的指导指征是基于植被长度。但是，它们没有指定应该使用哪种方式进行测量。经食管超声心动图(TOE)成像仅是人工心脏瓣膜或经胸超声心动图(TTE)不确定的I级指征。因此，并不是所有的IE患者都会接受TOE。我们调查了TTE和TOE测量植被长度是否存在差异以及对手术指征的潜在影响。方法回顾性分析68例明确心内膜炎患者，均行TOE和TTE影像学检查。在二维图像上测量植被长度。使用ESC 2015指南对TOE和TTE的植被长度进行了手术适应症的比较。结果TTE与TOE的中位间隔时间为2 d。21/68(30.8%)的患者在TOE上发现了植被，而在TTE上没有发现。在剩余的47例患者中，27例(57.4%)患者的TOE测量的植被比TTE测量的植被长，平均差异为7.8mm。2/47(4.3%)患者TOE与TTE的植被长度相同。18/47(38.3%)患者在TTE上测量的植被比TOE长，平均差异为4.3mm。植被总长度的平均差异为5.9mm。59例左侧心内膜炎患者中，16例(27.1%)的手术适应证是根据TOE植体长度而不是TTE植体长度来改变手术适应证。11/59(18.6%)病例从无手术指征变为IIa类，5/59(8.5%)病例从无手术指征变为IIb类。结论与TOE相比，TTE常低估植被长度。两种方式之间记录的植被长度的变化将改变27%的患者的手术指征，以防止栓塞。植被长度的测量，以确定手术干预预防栓塞应采取TOE成像，而不是TTE。利益冲突无

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11 Impact of transthoracic versus transoesophageal echocardiography measurement of vegetation length in infective endocarditis on indications for surgery

Introduction Infective Endocarditis (IE) has high mortality. Longer vegetation length is associated with increased stroke risk and mortality. Guideline indications for surgery to prevent embolism are based on vegetation length. However they do not specify which modality should be used for the measurement. Transoesophageal echocardiography (TOE) imaging is only a Class I indication for prosthetic heart valves or where trans-thoracic (TTE) is inconclusive. Therefore, not all patients with IE will undergo TOE. We investigated whether there are differences in TTE and TOE measurement of vegetation length and the potential impact on indications for surgery. Methods This was a retrospective study of 68 patients with definite endocarditis that had undergone both TOE and TTE imaging. Vegetation length was measured on two dimensional images. Indications for surgery to prevent embolism using the ESC 2015 guidelines were compared for vegetation length on TOE and TTE. Results The median time between TTE and TOE was 2 days. 21/68 (30.8%) patients with vegetations identified on TOE were not identified on TTE. Of the remaining 47 patients, 27 (57.4%) had longer vegetations measured on TOE than on TTE with the mean difference being 7.8mm. 2/47 (4.3%) patients had the same vegetation length on TOE as on TTE. 18/47 (38.3%) patients had longer vegetations measured on TTE than on TOE with the mean difference being 4.3mm. The mean difference in vegetation length overall was 5.9mm. Of the 59 patients with left sided endocarditis, 16 cases (27.1%) would change their surgical indication based on using TOE vegetation length rather than TTE vegetation length. 11/59 (18.6%) cases would change from no indication for surgery to a class IIa indication and 5/59 (8.5%) cases would change from no indication for surgery to a class IIb indication. Conclusion TTE often underestimates vegetation length compared to TOE. The change in vegetation length recorded between the two modalities would have changed the indication for surgery to prevent embolism in 27% patients. Measurements of vegetation length to determine surgical intervention for the prevention of embolization should be taken from TOE imaging rather than TTE. Conflict of Interest None

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ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy

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