Why the study?
Does contemporary transthoracic echocardiography provide accurate diagnosis of infective endocarditis compared to transesophageal echocardiography in patients with suspected endocarditis?
Does contemporary transthoracic echocardiography provide accurate diagnosis of infective endocarditis compared to transesophageal echocardiography in patients with suspected endocarditis?
Contemporary TTE demonstrates high sensitivity (81.8%) for detecting infective endocarditis, potentially reducing the need for TEE.
May support TTE-first strategies in select IE cases with good windows; leaves open whether TEE can be safely avoided.
BACKGROUND: Between 1987 and 1994, several studies demostrated transthoracic echocardiography (TTE) to be less sensitive than transesophageal echocardiography (TEE) in detecting native valve endocarditis. Recent technologic advances, especially the introduction of harmonic imaging and digital processing and storage, have improved TTE image quality. The aim of this study was to determine the diagnostic accuracy of contemporary TTE. METHODS: Between 2003 and 2007, 75 patients underwent both TTE and TEE for clinically suspected infective endocarditis. The diagnostic accuracy of TTE was assessed using transesophageal echocardiography as the gold standard for diagnosis of endocarditis. RESULTS: Of the 75 patients in this study, 33 were found to be positive by TEE. The sensitivity for detection of infective endocarditis by TTE was 81.8%. It provided good image quality in 81.5% of cases; in these patients sensitivity was even greater (89.3%). CONCLUSION: Contemporary TTE has improved the diagnostic accuracy of infective endocarditis by ameliorating image quality; it provides an accurate assessment of endocarditis and may reduce the need for TEE.
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Casella et al. (2009) studied this question.
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