The prospective role of transesophageal echocardiography in the diagnosis and management of patients with suspected infective endocarditis.
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.
Harris
Kevin M
KM
Minneapolis Heart Institute, Minneapolis, Minnesota 55407, USA. kharris@mplsheart.com
Li
Dean Y
DY
L'Ecuyer
Paul
P
Moon
Karl E T
KE
German
Matt
M
Fraser
Victoria
V
Barzilai
Benico
B
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
D000900:Anti-Bacterial Agents