Repeated echocardiographic examinations of patients with suspected infective endocarditis

Abstract

Objective: To study the diagnostic contribution of repeated transthoracic (TTE) and transoesophageal echocardiography (TOE) among patients with suspected infective endocarditis. Methods: 262 patients with 266 episodes of suspected infective endocarditis were referred for TTE and TOE over three years in a 423 bed university cardiology hospital. Patients were a mean (SD) of 47.6 (17.9) years old. 139 (52.3%) episodes occurred in men and 127 (47.7%) in women. The diagnostic information obtained from repeated TTE and TOE examinations was evaluated relative to the diagnosis of endocarditis. Results: TTE examinations were repeated in 192 (72.2%) and TOE examinations were repeated in 49 (18.4%) of 266 episodes. A mean of 2.4 TTE and 1.2 TOE examinations were performed for each episode of suspected endocarditis. The second and third TTEs added diagnostic information in 34 (26.7%) and the second and third TOEs added diagnostic information in 25 (19.7%) of 127 episodes with definite endocarditis. After the third TTE or TOE no additional diagnostic information was obtained. Conclusions:The diagnostic contribution of repeated TTE or TOE for the diagnosis of endocarditis decreased as the number of repetitions increased. In this setting, the data do not substantiate more than three TTE or TOE examinations as an efficient strategy to increase the diagnostic yield for all but selected patients with suspected endocarditis.

2015 ESC Guidelines for the management of infective endocarditis

“…Czułość klasyfikacji, oceniana na końcu obserwacji pacjenta w badaniach epidemiologicznych, wynosi ok. 80% [100]. Jednak w praktyce klinicznej zmodyfikowane kryteria Duke stosowane na wczesnym etapie choroby cechują się mniejszą dokładnością, szczególnie w przypadku zapalenia wsierdzia obejmującego sztuczną zastawkę (PVE) lub elektrodę układu stymulującego serce lub defibrylatora, w którym badanie echokardiograficzne jest prawidłowe lub nierozstrzygające u 30% pacjentów [101,102]. Postęp w zakresie technik obrazowania pozwolił na skuteczniejszą identyfikację zarówno zmian wewnątrzsercowych, jak i pozasercowych powikłań IZW [10,103].…”

Echocardiography in Fever Investigation in Patient with Long Term Central Venous Catheter

“…Possibilita maior resolução das imagens e melhor definição por apresentar maior proximidade das estruturas cardíacas, não sofrer interposição da parede torácica e utilizar transdutores com maior frequência. Quando o ETE inicial é negativo, mas a suspeita de endocardite permanece, a repetição do exame transesofágico em sete a dez dias pode estar indicada 10,11 .…”

Achados ecocardiográficos em pacientes com suspeita diagnóstica de endocardite infecciosa

“…In the present study, the transthoracic echocardiographies were repeated until the sixth examination, and the transesophageal echocardiographies until the fifth examination. No addition of diagnostic information was observed after the third examination, either transthoracic or transesophageal 22 . A greater frequency of stroke was observed in patients with endocarditis in whom vegetations with dimensions > 10 mm were identified, although a greater frequency of peripheral embolic phenomena correlated with the dimensions of the vegetations was not observed.…”