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. In 1 survey282 that included 4 echocar- diographers who were blinded to clinical data, interobserver agreement was mixed on the characterization of vegetations. Agreement was high for the presence of vegetation (98%) and involved site (97%); interobserver agreement was consider- ably less for vegetation size (73%), mobility (57%), shape (37%), and attachment (40%). However, all of the series that included >100 patients who underwent TEE showed a positive relationship between embolic events and vegetation size. Moreover, the study with the largest number of patients (n=176) that assessed the value of TEE and included silent embolism detected by CT scanning demonstrated that the risk of embolic events was highly related to vegetation size and mobility but not to other known risk factors associated with embolism in IE.283 The conflicting results on the relationship between echocardiography and embolic risk can be explained at least partially by the poor standardization of diagnostic cri- teria for IE in older series, inclusion or not of silent embolism, inclusion or not of previous embolism, echocardiographic method used, lack of focus on future embolic events after TEE, and sample size. 