Clinical implications of large vegetations in infectious endocarditis

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Abstract
Patients (34) with clinical infectious endocarditis [bacterial] were examined by M-mode and 2-dimensional (2D) echocardiography. Vegetations were identified in 16 patients (47%) by M-mode and in 27 patients (87%) by 2D echocardiography. Vegetations identified by 2D echocardiography were categorized as small (< 5 mm), medium (5 to 9 mm) or large (.gtoreq. 10 mm). Large vegetations were caused by a variety of organisms, had a higher incidence of surgery (44% vs. 0%) and had no increased incidence of stroke or death. The larger the vegetation, the more detectable it was by M-mode. Aortic valve vegetations were associated with a higher incidence of congestive heart failure (CHF) (67% vs. 14%) and stroke (44% vs. 9%). Four patients with large aortic valve vegetations had the highest complication rate; CHF developed in all 4, 2 had valve replacement, 1 had a stroke and 2 died.