**1. Introduction**

In general population, the infective endocarditis incidence has been estimated between 2 and 6 cases per 100,000 patient years, but it is significantly higher in patients with valvular heart disease and those with intravenous drug abuse. In 22–50% of cases of IE occurs systemic embolization [1–4] and up to 65% of EEs involves the central nervous system which

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

are associated with a higher mortality rate. The incidence of embolic complications is higher in IE located on aortic and mitral valve and in IE due to *Staphylococcus aureus*, Candida species, HACEK and Abiotrophia organisms. The highest rate of embolic events is seen within the first 2–4 weeks of antimicrobial therapy [5], and it drops dramatically during the first 2 weeks of successful antibiotic therapy, from 13 to <1.2 embolic events per 1000 patientdays. Prediction of individual patient risk for embolization has proven extremely difficult. Echocardiography is the main investigation used in a lot of studies to identify a high-risk subset of patients with IE who might benefit from early surgery in order to avoid embolization. Higher embolic rates revealed by several studies using transthoracic echocardiography (TTE) and TEE were seen with the increase of the VEG dimensions [6]. Vegetation mobility has not been shown to be an independent risk factor for embolic events, probably because it is strongly correlated with VEG size [5]. In other studies, the embolic complications were by the infecting organism and the number of VEG, the number of valves involved and VEG characteristics.

leukocytosis, anemia), type of IE (on native valve or prosthetic) and the type of the surgical intervention. The main outcome variables were: the presence and the type of EE, death

Prediction of Embolic Events in Infective Endocarditis Using Echocardiography

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• 69.91% of the patients presented positive blood cultures (24.58% with *Staphylococcus* 

occurrence and its causes.

*aureus*);

The characteristics of the studied group were as follows:

• a significant regurgitation murmur was present on 56.78% patients;

• 58% male, the mean age was 47.8 ± 6 years;

• 86.96% of the patients had fever >38°C;

• 38.14% of the patients presented anemia;

• 2.12% of the patients had prosthesis endocarditis;

• cardiac surgery was performed on 96.16% patients.

**Figure 1.** The echographic parameters measured on the vegetations.

• 77.12% of the patients were in NYHA class III;

That is why the first objective of our study was to identify the echographic parameters which were associated with the presence of an EE in patients with IE. Using these variables we tried to define the echographic parameters which can help in defining the high-risk groups for EE in IE patients and to evaluate the real value of the TEE for the EE prediction in these patients. Finally, we examined the relationship between the incidence of an EE occurrence during the antibiotic treatment and the type of antibiotherapy and the echographic predictors for a new EE during antibiotherapy.
