Importance: Infective endocarditis is a life-threating condition with annual mortality of as much as 40% and is associated with embolic events in as many as 80% of cases. These embolic events have notable prognostic implications and have been linked to increased length of stay in intensive care units and mortality. A vegetation size greater than 10 mm has often been suggested as an optimal cutoff to estimate the risk of embolism, but the evidence is based largely on small observational studies. Objective: To study the association of vegetation size greater than 10 mm with embolic events using meta-analytic techniques. Data Sources: A computerized literature search of all publications in the PubMed and EMBASE databases from inception to May 1, 2017, was performed with search terms including varying combinations of infective endocarditis, emboli, vegetation size, pulmonary infarct, stroke, splenic emboli, renal emboli, retinal emboli, and mesenteric emboli. This search was last assessed as being up to date on May 1, 2017. Study Selection: Observational studies or randomized clinical trials that evaluated the association of vegetation size greater than 10 mm with embolic events in adult patients with infective endocarditis were included. Conference abstracts and non-English language literature were excluded. The search was conducted by 2 independent reviewers blinded to the other's work. Data Extraction and Synthesis: Following PRISMA guidelines, the 2 reviewers independently extracted data; disputes were resolved with consensus or by a third investigator. Categorical dichotomous data were summarized across treatment arms using Mantel-Haenszel odds ratios (ORs) with 95% CIs. Heterogeneity of effects was evaluated using the Higgins I2 statistic. Results: The search yielded 21 unique studies published from 1983 to 2016 with a total of 6646 unique patients with infective endocarditis and 5116 vegetations with available dimensions. Patients with a vegetation size greater than 10 mm had increased odds of embolic events (OR, 2.28; 95% CI, 1.71-3.05; P < .001) and mortality (OR, 1.63; 95% CI, 1.13-2.35; P = .009) compared with those with a vegetation size less than 10 mm. Conclusions and Relevance: In this meta-analysis of 21 studies, patients with vegetation size greater than 10 mm had significantly increased odds of embolism and mortality. Understanding the risk of embolization will allow clinicians to adequately risk stratify patients and will also help facilitate discussions regarding surgery in patients with a vegetation size greater than 10 mm.
Importance: Infective endocarditis is a life-threating condition with annual mortality of as much as 40% and is associated with embolic events in as many as 80% of cases. These embolic events have notable prognostic implications and have been linked to increased length of stay in intensive care units and mortality. A vegetation size greater than 10 mm has often been suggested as an optimal cutoff to estimate the risk of embolism, but the evidence is based largely on small observational studies. Objective: To study the association of vegetation size greater than 10 mm with embolic events using meta-analytic techniques. Data Sources: A computerized literature search of all publications in the PubMed and EMBASE databases from inception to May 1, 2017, was performed with search terms including varying combinations of infective endocarditis, emboli, vegetation size, pulmonary infarct, stroke, splenic emboli, renal emboli, retinal emboli, and mesenteric emboli. This search was last assessed as being up to date on May 1, 2017. Study Selection: Observational studies or randomized clinical trials that evaluated the association of vegetation size greater than 10 mm with embolic events in adult patients with infective endocarditis were included. Conference abstracts and non-English language literature were excluded. The search was conducted by 2 independent reviewers blinded to the other's work. Data Extraction and Synthesis: Following PRISMA guidelines, the 2 reviewers independently extracted data; disputes were resolved with consensus or by a third investigator. Categorical dichotomous data were summarized across treatment arms using Mantel-Haenszel odds ratios (ORs) with 95% CIs. Heterogeneity of effects was evaluated using the Higgins I2 statistic. Results: The search yielded 21 unique studies published from 1983 to 2016 with a total of 6646 unique patients with infective endocarditis and 5116 vegetations with available dimensions. Patients with a vegetation size greater than 10 mm had increased odds of embolic events (OR, 2.28; 95% CI, 1.71-3.05; P < .001) and mortality (OR, 1.63; 95% CI, 1.13-2.35; P = .009) compared with those with a vegetation size less than 10 mm. Conclusions and Relevance: In this meta-analysis of 21 studies, patients with vegetation size greater than 10 mm had significantly increased odds of embolism and mortality. Understanding the risk of embolization will allow clinicians to adequately risk stratify patients and will also help facilitate discussions regarding surgery in patients with a vegetation size greater than 10 mm.
Authors: J S Li; D J Sexton; N Mick; R Nettles; V G Fowler; T Ryan; T Bashore; G R Corey Journal: Clin Infect Dis Date: 2000-04-03 Impact factor: 9.079
Authors: R Erbel; S Rohmann; M Drexler; S Mohr-Kahaly; C D Gerharz; S Iversen; H Oelert; J Meyer Journal: Eur Heart J Date: 1988-01 Impact factor: 29.983
Authors: Larry M Baddour; Walter R Wilson; Arnold S Bayer; Vance G Fowler; Imad M Tleyjeh; Michael J Rybak; Bruno Barsic; Peter B Lockhart; Michael H Gewitz; Matthew E Levison; Ann F Bolger; James M Steckelberg; Robert S Baltimore; Anne M Fink; Patrick O'Gara; Kathryn A Taubert Journal: Circulation Date: 2015-09-15 Impact factor: 29.690
Authors: G Di Salvo; G Habib; V Pergola; J F Avierinos; E Philip; J P Casalta; J M Vailloud; G Derumeaux; J Gouvernet; P Ambrosi; M Lambert; A Ferracci; D Raoult; R Luccioni Journal: J Am Coll Cardiol Date: 2001-03-15 Impact factor: 24.094
Authors: S De Castro; G Magni; S Beni; D Cartoni; M Fiorelli; M Venditti; S L Schwartz; F Fedele; N G Pandian Journal: Am J Cardiol Date: 1997-10-15 Impact factor: 2.778
Authors: Bruno Hoen; François Alla; Christine Selton-Suty; Isabelle Béguinot; Anne Bouvet; Serge Briançon; Jean-Paul Casalta; Nicolas Danchin; François Delahaye; Jerome Etienne; Vincent Le Moing; Catherine Leport; Jean-Luc Mainardi; Raymond Ruimy; François Vandenesch Journal: JAMA Date: 2002-07-03 Impact factor: 56.272
Authors: H O Jung; K B Seung; D H Kang; M Y Lee; W S Chung; J J Kim; S J Chae; J H Kim; S J Hong; K B Choi Journal: Korean J Intern Med Date: 1994-07 Impact factor: 2.884
Authors: Alvin Yang; Charlie Tan; Neill K J Adhikari; Nick Daneman; Ruxandra Pinto; Bennett K M Haynen; Gideon Cohen; Mark S Hansen Journal: PLoS One Date: 2019-04-25 Impact factor: 3.240