Overuse of Transthoracic Echocardiography in the Diagnosis of Native Valve Endocarditis

Kuruppu, Janaki; Corretti, Mary C.; Mackowiak, Philip A.; Roghmann, Mary-Claire

doi:10.1001/archinte.162.15.1715

Cited by 41 publications

(17 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although there is no data on optimal timing of echocardiographic assessment in the case of suspected endocarditis, American and European Guidelines on management of IE recommend echocardiography at the earliest possible opportunity [5,9]. However, increasing overuse of echocardiography in the setting of suspected IE with low pre-test probability has been noted [11,12].…”

Section: Introductionmentioning

confidence: 99%

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

2013

Cardiovasc Med

View full text Add to dashboard Cite

SummaryBackground: The optimal timing of the initial echocardiographic assessment and the influence of microorganisms on echocardiographic findings in patients with infective endocarditis (IE) are not well studied.Methods: In 274 patients with IE, we studied the impact of antibiotic treatment duration of ≤2 days (early, 119 patients) or >2 days (late, 144 patients) prior to diagnostic echocardiography on IE specific findings and on clinical outcomes. Results were stratified for patients with Staphylococcus aureus (SA patients, n = 84) and those with other causative organisms (non-SA patients, n = 190).Results: There were no differences on specific echocardiographic findings between patients with early versus late echocardiography: Presence of vegetations: 91% vs 86%, p = 0.25; size of vegetations: 1.5 ± 0.7 cm vs 1.5 ± 0.8 cm, p = 0.83; paravalvular abscess: 24% vs 24%, p = 0.88, or valve destruction: 44% vs 35%, p = 0.17. There were also no differences in terms of clinical outcomes between the two groups: Heart surgery for IE in 61% vs 53%, p = 0.21, and in-hospital death in 8% vs 11%, p = 0.46. The presence of SA was not associated with specific findings on echocardiography or worse clinical outcomes compared to non-SA patients.Conclusions: In patients with infective endocarditis, the findings of early vs late initial echocardiographic a ssessment did not differ, and echocardiographic findings did not allow inference on the causing organism. Neither the timing of the initial echocardiographic study nor any organism involved was associated with clinical outcome.

show abstract

Section: Introductionmentioning

confidence: 99%

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

2013

Cardiovasc Med

View full text Add to dashboard Cite

show abstract

“…Secondly, a critical aspect of echocardiography in diagnosing IE is the pretest likelihood of disease. Even a modest approach such as use of TTE in screening for IE in groups that have low or moderate risk of disease will generate very low yield [18,19]. Linder et al evaluated the hypothesis that TEE should be reserved only for patients with high risk of disease [20].…”

Section: Discussionmentioning

confidence: 99%

Swedish guidelines for diagnosis and treatment of infective endocarditis recommend overuse of transoesophageal echocardiography

Dencker

Roijer

2008

Scandinavian Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…For example, a prospective observational study of patients evaluated for IE at an inner-city hospital showed that the majority (70%) of TTEs were ordered in patients with low probability of IE using the older IE diagnostic criteria of von Reyn et al [22]. TTE results did not change the diagnosis or antibiotic management of any of the patients in the low probability group [23]. Similarly, in a prospective study of patients evaluated for IE in a nonurban hospital, the majority of patients with low probability of defining IE by von Reyn criteria also had low probability of identifying occult IE cases by echocardiography (TTE and TEE).…”

Section: Echocardiography To Rule Out Iementioning

confidence: 99%

Use of echocardiography in the diagnosis and management of infective endocarditis

Chu

Bayer²

2007

Curr Infect Dis Rep

View full text Add to dashboard Cite

The first use of echocardiography in infective endocarditis (IE) was described in 1973. Since then, echocardiography has emerged as a major tool for the diagnosis and management of this disease. In general, transthoracic echocardiography (TTE) is adequate for diagnosing IE in cases where cardiac structures-of-interest are well visualized. Specific situations where transesophageal echocardiography is preferred over TTE include the presence of a prosthetic device, suspected periannular complications, children with complex congenital cardiac lesions, selected patients with Staphylococcus aureus bacteremia, and certain pre-existing valvular abnormalities that make TTE interpretation problematic (eg, calcific aortic stenosis). Echocardiography is also useful for risk stratification. Evidence suggests that vegetation size can predict embolic complications, although the data are inconsistent. Careful clinical assessment is essential to the proper use of echocardiography in diagnosing IE, visualizing complications related to IE, and evaluating candidacy for surgical intervention.

show abstract

Overuse of Transthoracic Echocardiography in the Diagnosis of Native Valve Endocarditis

Abstract: Most TTEs are obtained in patients with a low pretest probability of IE and do not contribute to therapeutic decision making. We propose a diagnostic algorithm to direct the use of TTE to patients with intermediate or high pretest probability of IE.

Cited by 41 publications

References 26 publications

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

Swedish guidelines for diagnosis and treatment of infective endocarditis recommend overuse of transoesophageal echocardiography

Use of echocardiography in the diagnosis and management of infective endocarditis

Contact Info

Product

Resources

About