Key result
Transesophageal echocardiography confirmed infective endocarditis in 46% of high-probability patients and led to a management change in 31%, but rarely changed management in low-probability patients.
Why the study?
Does transesophageal echocardiography improve diagnosis and change management in patients with suspected infective endocarditis?
Observational (n=43)
Does transesophageal echocardiography improve diagnosis and change management in patients with suspected infective endocarditis?
TEE is most useful for confirming diagnosis and guiding management in patients with a high clinical probability of infective endocarditis, but has low utility in low-probability patients.
Supports selective TEE use in high-probability suspected IE; leaves open broader utility without prospective validation.
STUDY OBJECTIVES: Transesophageal echocardiography (TEE) has a high sensitivity for the diagnosis of infective endocarditis (IE), but the prospective role of TEE when added to a careful clinical examination has not been well-studied. DESIGN: We compared the results of TEE to a clinical evaluation by an infectious disease specialist in 43 consecutive patients in whom TEE was ordered to rule out IE. Prior to TEE, the patients were classified on clinical grounds as to their likelihood of IE using a modification of the von Reyn criteria. Changes in management occurring as a result of TEE also were evaluated. MEASUREMENTS AND RESULTS: TEE was positive in 11 patients, negative in 29, and indeterminate in 3. TEE was positive in 6 (46%) of 13 high probability patients, 2 (67%) of medium probability patients, and 3 (11%) of 27 low probability patients. A change in management based on TEE occurred in 4 (31%) patients with high probability, in no patients with medium probability, and in 1 (4%) patient with low probability. CONCLUSIONS: TEE confirms IE in patients with high probability of IE and often leads to a management change. However, TEE is unlikely to establish the diagnosis or change management in patients with low probability.
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Harris et al. (2003) conducted an observational in Suspected infective endocarditis (n=43). Transesophageal echocardiography (TEE) vs. Clinical evaluation was evaluated on Positive TEE result and change in management. Transesophageal echocardiography confirmed infective endocarditis in 46% of high-probability patients and led to a management change in 31%, but rarely changed management in low-probability patients.
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