title: The prospective role of transesophageal echocardiography in the diagnosis and management of patients with suspected infective endocarditis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Minneapolis Heart Institute, Minneapolis, Minnesota 55407, USA. kharris@mplsheart.com
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Harris
authors.forename: Dean Y
authors.initials: DY
authors.lastname: Li
authors.forename: Paul
authors.initials: P
authors.lastname: L'Ecuyer
authors.forename: Karl E T
authors.initials: KE
authors.lastname: Moon
authors.forename: Matt
authors.initials: M
authors.lastname: German
authors.forename: Victoria
authors.initials: V
authors.lastname: Fraser
authors.forename: Benico
authors.initials: B
authors.lastname: Barzilai
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination; D011336:Probability; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents