The Role of Two-Dimensional Echocardiography in the Diagnosis of Ineffective Endocarditis

Abstract

Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infective endocarditis. Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis. The diagnosis of endocarditis was determined by strict clinical and laboratory criteria. All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed. Five echocardiograms were technically inadequate, resulting in a study population of 101 patients. The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years). The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%). Twelve patients had preexisting valvular or congenital heart disease. Gram-positive cocci were the most common microorganisms. Complications included mitral regurgitation, subarachnoid hemorrhage, renal infarction, stroke, and a pulmonary embolus. The patients were divided into two groups: Group I consisted of 36 patients with definite vegetations by echocardiography, and Group II had 65 patients with no vegetations. In Group I, acute infective endocarditis was present in 35 patients, whereas only 4 patients had endocarditis in Group II. The sensitivity of two-dimensional echocardiography for detecting endocarditis was 90%. The specificity was 98%. The predictive accuracy for a positive test was 97%, and the predictive accuracy for a negative test was 94%. Thus, two-dimensional echocardiography appears to have a high sensitivity, specificity, and predictive value in the evaluation of patients with suspected endocarditis.

The Diagnostic Utility of Transthoracic Echocardiography for the Diagnosis of Infective Endocarditis in the Real World of the Italian Registry on Infective Endocarditis

“…An important finding of the present study is that the sensitivity of TTE for the diagnosis of IE (65%) was almost the same (62%) of those reported by a meta‐analysis of 7 studies performed between 1989 and 1994; nevertheless it is an imperfect comparison: reported observations were derived from the real world of a multicenter registry with a focus on the first diagnostic echocardiographic examination. Echocardiograms were performed early: almost 50% of all TTE were performed before admission (Table ), and several echo findings may become significant in a subsequent time.…”

“…The initial echocardiographic modality sufficient for initial diagnosis has been subject of debate for years . Many studies have demonstrated that, compared with TTE, TEE is more accurate for the diagnosis of IE especially when prosthetic valve infection or perivalvular complications (such as abscess and fistula) are present . However it is semi‐invasive, less well tolerated, costly and not available in all echocardiographic laboratories.…”

“…However it is semi‐invasive, less well tolerated, costly and not available in all echocardiographic laboratories. The comparative efficacy of TTE and TEE in the diagnosis of IE has been extensively evaluated by several studies, most of which were carried on before recent advances in imaging technology became available …”

“…[5][6][7] Many studies have demonstrated that, compared with TTE, TEE is more accurate for the diagnosis of IE especially when prosthetic valve infection or perivalvular complications (such as abscess and fistula) are present. [11][12][13][14][15][16][17][18] However it is semi-invasive, less well tolerated, costly and not available in all echocardiographic laboratories. The comparative efficacy of TTE and TEE in the diagnosis of IE has been extensively evaluated by several studies, most of which were carried on before recent advances in imaging technology became available.…”

“…9 Most studies comparing TTE vs. TEE for the diagnosis of IE are dated and have been published in the 1990s, when both modalities showed a high specificity (96% vs. 95%) [10][11][12][13][14][15][16][17][18] while TTE had a lower sensitivity: 79% in a metaanalysis of older studies, 10 62% in 7 studies between 1989-94, compared to that reported by TEE (92%). [11][12][13][14][15][16][17][18] Afterwards relatively few data have been reported, despite a significant technologic improvement of TTE imaging (namely harmonic imaging, superior probe design echo system based on digital platforms), that has been responsible of high quality imaging especially in more recent and performing equipments. The aim of the study was to report updated data on the diagnostic sensitivity of TTE and TEE, performance times, and the diagnostic utility from the RIEI (IE Italian Registry) as evidence of a real world situation.…”