感染性心内膜炎伴心功能不全超声表现北大核心CSCD

目的观察感染性心内膜炎(IE)伴心功能不全超声表现及其诊断价值。方法回顾性收集98例IE伴心功能不全患者,根据纽约心脏协会(NYHA)分级将其分为NYHAⅡ级组(n=30)、NYHAⅢ级组(n=43)及NYHAⅣ级组(n=25);对比3组临床及超声资料,将组间差异有统计学意义的指标纳入logistic回归分析,观察各指标与IE伴心功能不全的关系。结果98例中,45例血培养阳性(45/98,45.92%),其中24例(24/45,53.33%)致病菌为甲型溶血性链球菌;67例(67/98,68.37%)合并心脏基础疾病,其中19例(19/67,28.36%)合并二叶主动脉瓣。经手术治疗后,77例症状减轻,NYHAⅢ级组8例、NYHAⅣ级组13例死亡。3组合并瓣膜反流、赘生物累及多个瓣膜及瓣叶穿孔病例占比差异均有统计学意义(P均<0.05),且重度瓣膜反流、赘生物累及多个瓣膜及瓣叶穿孔是评估IE伴心功能不全分级的独立预测因素(P均<0.05)。结论IE伴心功能不全超声心动图可表现为重度瓣膜反流、赘生物累及多个瓣膜和瓣叶穿孔;根据上述表现可预测其分级。

Ultrasonic manifestations of infective endocarditis complicated with cardiac insufficiency

Objective To observe ultrasonic manifestations of infective endocarditis(IE)complicated with cardiac insufficiency,and to assess the diagnostic value of these findings.Methods Totally 98 patients with IE complicated with cardiac insufficiency were enrolled and divided into New York Heart Association(NYHA)gradeⅡgroup(n=30),NYHA gradeⅢgroup(n=43)and NYHA gradeⅣgroup(n=25).The clinical and ultrasonic data were compared among 3 groups.Indexes being statistically different among 3 groups were enrolled in logistic regression analysis to observe the relationships of above indexes and IE complicated with cardiac insufficiency.Results Among 98 patients,positive blood culture test(45/98,45.92%)was found in 45,and the pathogenic bacteria of 24 cases(24/45,53.33%)wasα-hemolytic streptococcus.Totally 67 cases(67/98,68.37%)complicated with basic cardiac diseases,including 19(19/67,28.36%)complicated with bicuspid aortic valve.After surgical operation,the symptoms relieved in 77 cases,while 8 patients in NYHA gradeⅢgroup and 13 patients in NYHA gradeⅣgroup died.There were significant differences of the ratio of cases with valve regurgitation,vegetation involving multiple valves and valve leaflet perforation among 3 groups(all P<0.05).Severe valve regurgitation,vegetation involving multiple valves and valve leaflet perforation were independent predictors of the classification of IE complicated with cardiac insufficiency(all P<0.05).Conclusion IE might present as severe valve regurgitation,vegetation involving multiple valves and valve leaflet perforation on echocardiogram,which could be used to predict and grade IE complicated with cardiac insufficiency.