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Diagnostic and prognostic relevance of valve strands in patients with suspected infective endocarditis

Georgios Tzimas1, Pierre Monney1, Nicoleta Ianculescu1

  • 1Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 19, 2026
PubMed
Abstract

Insights

Valve strands, or Lambl's excrescences, are often mistaken for infective endocarditis (IE). Differentiating these findings through expert evaluation can prevent unnecessary treatment for suspected IE.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Valve strands (Lambl's excrescences) are common findings, but their clinical significance in suspected infective endocarditis (IE) is not well-defined.
  • Distinguishing valve strands from true IE vegetations is crucial for appropriate patient management and avoiding overtreatment.

Purpose of the Study:

  • To evaluate the impact of valve strand diagnosis on patient outcomes in those investigated for suspected IE.
  • To assess the differentiation between valve strands and IE and its effect on management decisions.

Main Methods:

  • Retrospective analysis of adult patients with valve strands identified via cardiac imaging (2014-2024) at Lausanne University Hospital.
  • Classification of episodes as IE or non-IE by a multidisciplinary Endocarditis Team or expert clinicians.
  • One-year follow-up for recurrence of bacteremia/candidemia or IE.

Main Results:

  • Of 305 valve strand episodes, 33% were diagnosed as IE; 81% of non-IE episodes had bacteremia/candidemia.
  • Echocardiography identified valve strands in 50% (transthoracic) to 79% (transesophageal) of cases.
  • One-year recurrence of IE was significantly higher in confirmed IE cases (7%) versus non-IE (1%), P=0.029.

Conclusions:

  • The majority of valve strands detected in suspected IE cases are not infectious lesions.
  • Expert cardiologists and multidisciplinary teams can effectively differentiate valve strands from vegetations.
  • Accurate differentiation reduces the need for unnecessary antimicrobial or surgical treatment for IE.
Keywords:
Lambl’s excrescencesinfective endocarditistransesophageal echocardiographytransthoracic echocardiographyvalve strands

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