Tricuspid valve endocarditis due to Staphylococcus aureus: Correlation of two-dimensional echocardiography with clinical outcome

We studied 53 episodes (51 patients) of tricuspid valvular endocarditis caused by Staphylococcus aureus in a predominantly addicted population and correlated two-dimensional echocardiographic findings with clinical outcome. Thirty-eight episodes with (vs 15 episodes without)tricuspid vegetations on the two-dimensional echocardiogram were significantly associated with (1)longer duration of fever on therapy (mean of 12.3 days vs 6.8 days, respectively; p<0.005); and (2) higher frequency of increased right ventricular end-diastolic (RVED) dimension (25 of 38 cases [66 percent] vs two of 15 cases [13 percent], respectively; p<0.01). Only patients with increased RVED dimension (5/25; 20 percent) required tricuspid valvular surgery for prolonged fever or progressive right-sided heart failure (p<0.05 vs patients with normal RVED dimension). Tricuspid vegetations greater than 1.0 cm identified a subset of patients at increased risk for developing clinical right-sided heart failure during the active or convalescent phase of endocarditis (p<0.02 vs patients with tricuspid vegetations less than 1.0 cm). An unexpectedly high prevalence of asymptomatic prolapse of the mitral valve was observed in this population (23 of 53 episodes; 43 percent). Detection of tricuspid vegetations in patients with endocarditis due to S aureus is not a primary indication for early surgery, but identifies patients more likely to exhibit short-term and long-term complications of their infection.