A Clinical Practice Guideline Appraisal for Appropriate Use of Echocardiography in Adult Infective Endocarditis—When to and by Which Mode to Perform an Echo?

Abstract

BackgroundEchocardiography (Echo) is the primary imaging modality of infective endocarditis (IE). The recommendations on timing and mode selection of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) are not fully in agreement among different guidelines, which can be confusing for clinical decision makers. Thus, we aimed to appraise the quality of recommendations by appraising the quality of guidelines. MethodsA search of guidelines published in English during 2007 to 2020 which contains recommendations of appropriate use of Echo in IE adult patients has been conducted. PPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviews to assess the integrated quality of identified guidelines. The recommendations of concern were extracted from related chapters.ResultsA total of 9 guidelines meet the criteria with AGREE II score ranging from 36% to 79%, the domain of “stakeholder involvement” got the lowest score. According The most debatable issue is that under what circumstances has the repeated TEE for an initial positive TTE been necessary in suspected IE, the conflicting recommendations on it were presented along with relatively lower evidence level for hardly any related evidence based on.ConclusionsIn the 9 guidelines identified, the recommendations over the appropriate use of Echo are generally satisfying. Clinicians could take into account the guideline quality score when evaluating the recommendations for clinical decision making. More researches with high-grade evidence above the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE are needed in the future.