心脏超声对感染性心内膜炎诊断价值的再评价

Reassessment of Echocardiography for Diagnosing Infectious Endocarditis

目的:探讨心脏超声在感染性心内膜炎(IE)诊断中的应用价值。方法:入选2013-01至2015-06就诊于本中心初步诊断为心血管植入式电子装置(CIED)感染的患者共478例。其中,根据症状、常规血培养、心脏超声检查疑似IE者9例,进一步接受正电子发射计算机断层摄影术(PET-CT)检查,以明确诊断及分型。然后,根据诊断分别进行针对性治疗,随访一年,检验心脏超声检查对CIED患者IE诊断的准确性。结果:3例患者因心脏超声未发现赘生物而初步诊断为菌血症,但经PET-CT检查后最终诊断为IE。2例患者心脏超声提示瓣膜赘生物而初步诊断为IE,但经PET-CT检查后发现心腔内电极导线及瓣膜均未见赘生物,其中1例伴随血培养阳性,最终诊断为菌血症,另1例无感染征象者最终诊断为非感染患者。4例患者在电极导线拔除术后因心脏超声可见赘生物而初步诊断为IE,但PET-CT检查发现心腔内无感染征象,最终确定为"非感染性纤维残留组织"。根据最终诊断分别采取针对性治疗,随访至少1年,所有患者均未出现新增感染及感染复发。结论:心脏超声对心腔内赘生物的判定存在误差,尤其对于接受电极导线拔除术后的疑似IE患者,应结合其他检查方法进行确定诊断,制定正确的治疗策略。

Objective： To explore the value of echocardiography for diagnosing infectious endocarditis （IE）. Methods： A total of 487 patients with cardiovascular implantable electronic devices （CIED） infection treated in our hospital from 2013-01 to 2015-06 were enrolled. Based on symptoms, blood culture and echocardiography, 9 patients with suspected IE were further examined by ^18F-FDG PET-CT to confirm their diagnosis and classification. Definitive therapy was conducted and the patients were followed-up for 1 year to confirm the diagnostic accuracy of echocardiography on CIED induced IE. Results： 3 patients were preliminarily diagnosed for bacteremia since no vegetation was found by echocardiography, while IE was finally diagnosed by PET-CT. 2 patients were preliminarily diagnosed for IE by echocardiography presented valvular vegetation, while PET-CT showed no evidence of vegetation; then one of them was diagnosed as bacteremia by positive blood culture and another was diagnosed as non-infection. 4 patients were preliminarily diagnosed for IE by echocardiography indicated existing vegetation after CIED lead extraction, while PET-CT demonstrated no infection sign in heart chamber and the finally diagnosed was as ＂non-infectious fibrous residual tissue＂. According to final diagnosis, definitive therapies were performed to specific patients with at least 1 year follow-up study, no one had new and recurrent infection. Conclusion： Echocardiography had deficiency for diagnosing vegetation in heart chamber especially in suspicious IE patients after CIED lead extraction. It is necessary to make accurate diagnosis with other method for guiding appropriate therapy.