Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023;30(1):68-72.
doi: 10.5603/CJ.a2022.0119. Epub 2023 Jan 2.

Measurement of vegetations in infective endocarditis: An inaccurate method to decide the therapeutical approach

Gonzalo Cabezón Villalba  1 , Javier López  2 , Pablo Elpidio Garcia-Granja  2 , Teresa Sevilla  2 , Ana Revilla  2 , Maria de Miguel  2 , Paloma Pulido  2 , Itziar Gómez  2 , J Alberto San Román  2
Affiliations

Measurement of vegetations in infective endocarditis: An inaccurate method to decide the therapeutical approach

Gonzalo Cabezón Villalba et al. Cardiol J. 2023.

Abstract

Background: The European Society of Cardiology and American Heart Association guidelines give a central role to the maximal vegetation diameter in the indication for surgery to prevent embolism in left sided infective endocarditis. Vegetation measuring is likely to be inaccurate. The hypothesis herein, is that the vegetation diameter is not an appropriate surgical criterion given the variability of its measurement.

Methods: Two trained echocardiographers independently measured the maximal vegetation diameter by transesophageal echocardiogram of 76 vegetations in 67 consecutive patients with definite infective endocarditis in an off-line workstation. The interobserver variability was calculated by the interclass correlation coefficient. The relationship between the strength of agreement for the cut-off points of 10 and 15 mm was also calculated. Finally, the number of patients whose surgical indication would have changed depending on which operator measured the vegetation was evaluated.

Results: Interobserver interclass correlation coefficient in the measurement of the maximal longitudinal diameter of the vegetations was 0.757 (0.642-0.839). The strength of agreement of the interobserver analysis for the cut-off point of 10 mm was 0.533 (0.327-0.759). For the cut-off point of 15 mm it was 0.475 (0.270-0.679). If heart failure or uncontrolled infections had been absent, the surgical indication would have changed in a total of 33 patients (33/76; 43%) depending on which operator measured the vegetation.

Conclusions: The variability in the measurements of the maximal longitudinal diameter by transesophageal echocardiogram is high. Surgical indications based on the cut-off points recommended by the international guidelines should be revised.

Keywords: embolism prevention; endocarditis; interobserver variability; surgery; vegetation size.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Blant-Almant plots evaluating inter-observer variability.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) Eur Heart J. 2015;21:3075–3128. doi: 10.1093/eurheartj/ehv319. - DOI - PubMed
    1. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e35–e71. doi: 10.1161/CIR.0000000000000932. - DOI - PubMed
    1. Dickerman SA, Abrutyn E, Barsic B, et al. ICE Investigators. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS) Am Heart J. 2007;154(6):1086–1094. doi: 10.1016/j.ahj.2007.07.023. - DOI - PubMed
    1. Vilacosta I, Graupner C, San Román JA, et al. Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol. 2002;39(9):1489–1495. doi: 10.1016/s0735-1097(02)01790-4. - DOI - PubMed
    1. Yang A, Tan C, Daneman N, et al. Clinical and echocardiographic predictors of embolism in infective endocarditis: systematic review and meta-analysis. Clin Microbiol Infect. 2019;25(2):178–187. doi: 10.1016/j.cmi.2018.08.010. - DOI - PubMed