1-041 Optimising imaging in infective endocarditis: assessing echocardiography use and diagnostic outcomes

Introduction The diagnosis and management of infective endocarditis (IE) present significant challenges, requiring timely and accurate diagnostic strategies. This study aims to assess the use of echocardiography in patients with suspected IE, examine adherence to ESC criteria, explore the role of alternative imaging modalities, and evaluate the final patient outcomes. Methods We conducted a retrospective analysis of all transthoracic echocardiography (TTE) requests related to suspected IE from January 3, 2023, to December 28, 2023. The analysis included TTE, transoesophageal echocardiography (TOE), PET scans, patient information, as well as microbiology data on microorganisms and cultures prompting the echocardiography requests. Results A total of 209 echocardiography requests for suspected or confirmed infective endocarditis (IE) were reviewed. Of these, 87% (181) originated from non-cardiac wards, and only 98/209 (47%) were recommended by specialists. Among the transthoracic echocardiography (TTE) results, 5% were positive, 9% indeterminate, and 86% showed no evidence of IE. Transoesophageal echocardiography was positive in 4 out of 7 cases, and 1 PET scan was positive. Overall, 15% of the imaging results were positive, 6% indeterminate, and 87% did not have any imaging features of IE. According to the ESC 2023 criteria, 7% (15) of the cases were classified as definite IE, 27% (57) as possible IE, and 66% (137) as negative for IE. A total of 26 patients received treatment for IE, with 88% (23/26) of the requests for these treated cases coming from specialists. Conclusions Most patients (87%) who undergo echocardiography as the first test for infective endocarditis show no imaging evidence of the condition, and only 12% ultimately receive treatment for IE. This has significant resource implications for an already overburdened service. By following the recommendations of specialists, the total number of requests could be reduced by almost half.