The association was strengthened when the analysis was limited to those patients who had not yet experienced a clinical embolic event. Another prospective TEE study, however, found no clear correlation of vegetation size with embolization.59 Nevertheless, the same investigators later reported the results of a new prospective study of 118 patients who underwent TEE and found that, on multivariable analysis, risk factors associated with embolic risk included vegetation size >10 mm and mitral valve involvement.56 Overall, these data are com- patible with previous observations that indicate that, in gen- eral, mitral vegetations of any size are associated with a higher risk of embolization (25%) than aortic vegetations (10%). As noted above, the highest embolic risk (37%) has been seen in the subset of patients with mitral vegetations attached to the anterior rather than the posterior mitral leaflet.59,63 This sug- gests that the mechanical effects of broad and abrupt leaflet excursion, occurring twice per heartbeat, may contribute to the propensity of a vegetation in this location to fragment and embolize. In another study, the effect of vegetation size on embolic potential was dependent on the infecting organism, with large vegetations independently predicting embolic events only in the setting of streptococcal IE.60 In contrast, as confirmed above byVilacosta et al,278 staphylococcal or fungal IE appears to carry a high incidence rate of embolization independently of vegetation size. Prognosis based on echocardiographic findings was exam- ined in a large, multicenter, prospective investigation. On the basis of TEE findings in 384 consecutive adult patients with definite IE, vegetation length >15 mm was a predictor of 1-year mortality (adjusted relative risk, 1.8; 95% confidence The role of echocardiography in predicting embolic events has been controversial. 