Transthoracic echocardiography (TTE): Sufficiently sensitive screening test for native valve infective endocarditis (IE)

Abstract We recently reviewed our experience with paired transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) studies for the diagnosis of native valve infective endocarditis. In patients with normal heart valves, we demonstrated that a normal TTE effectively rules out infecti...

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Bibliographic Details
Published in:Heart & lung 2011-07, Vol.40 (4), p.358-360
Main Authors: McDermott, Brian P., DO, Cunha, Burke A., MD, Choi, David, MD, Cohen, Jerald, MD, Hage, Jean, MD
Format: Article
Language:English
Subjects:
Calcified/thickened cardiac valves
Cardiac vegetations
Cardiology
Cardiovascular
Cardiovascular disease
Continuous/high-grade bacteremia
Coronary vessels
Critical Care
Echocardiography - instrumentation
Echocardiography, Transesophageal
Endocarditis - diagnostic imaging
Endocarditis - pathology
Humans
Marantic endocarditis
Medical screening
Mimics of endocarditis
Predictive Value of Tests
Pulmonary/Respiratory
Screening tests for infective endocarditis
Transesophageal echocardiography (TTE)
Ultrasonic imaging
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Summary:Abstract We recently reviewed our experience with paired transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) studies for the diagnosis of native valve infective endocarditis. In patients with normal heart valves, we demonstrated that a normal TTE effectively rules out infective endocarditis and a TTE is unnecessary. In patients with abnormal heart valves, a TEE did not enhance the diagnostic yield in most patients (12/15). We reviewed 87 paired TTEs and TEEs, that is, TEE with a preceding TTE performed for the evaluation of native valve IE. Of 87 paired echocardiograms, 72 of 87 had normal TTEs and TEEs, with no evidence of a vegetation indicative of infective endocarditis. A total of 15 of 87 TTEs had thickened/calcified valves without a definite vegetation. Of these, only 3 of 15 were subsequently shown to have a vegetation indicative of endocarditis by TEE. In patients with possible native valve infective endocarditis, before blood culture results are known, a negative TTE was sufficiently specific to rule out native valve infective endocarditis. Our data showed that the negative predictive value of a normal TTE in the evaluation of possible native valve endocarditis is 90% or greater. In those with some valve abnormality (ie, thickened/calcified heart valves), subsequent TTE did not materially increase vegetation detection.
ISSN:0147-9563
1527-3288
DOI:10.1016/j.hrtlng.2010.07.007