Multiple studies have shown that vegetation size is
directly correlated with complications and mortality.
Sanfilippo et al. found that the probability of sustaining
a complication of IE was 10% when vegetations were
≤6 mm in size, 50% for lesions 7 to 11 mm, and almost
100% for lesions >15 mm in size [6]. After adjusting for
multiple factors, Nunes et al. demonstrated that vegetation
length was the only independent predictor of inhospital
mortality [7]. Thuny et al. demonstrated that
large vegetations (>10 mm) and/or high vegetation mobility
were associated with an increased embolic risk [8].
Because larger IE lesions may be most amenable to detection
on bedside EUS, focused emergency ultrasound
may be helpful in identifying those patients who are at
greatest risk from this disease. Armed with this knowledge,
the detection of a large cardiac vegetation on bedside
TTE by the EP in a patient with suspicion for IE
can prompt earlier aggressive treatment and specialty
consultation without undue delay.