title: Impact of harmonic imaging on transthoracic echocardiographic identification of infective endocarditis and its complications.
abstract: OBJECTIVE
  To evaluate the comparative diagnostic value of harmonic imaging (HI) in the assessment of patients with suspected infective endocarditis (IE).
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  139 consecutive patients were evaluated with three imaging modalities: transthoracic echocardiography with fundamental imaging (FI); HI; and transoesophageal echocardiography (TOE). Image quality was assessed for each modality by semiquantitative scoring (0, poor, to 3, excellent). Presence, dimension, and characteristics of vegetations were assessed separately for each imaging modality, as well as presence of abscesses.
  
  
  RESULTS
  35 patients had definite IE. TOE was positive in 33 patients, HI in 28, and FI in 12 (p < 0.001 for FI v HI and v TOE). Mean image quality was 1.4 (0.7) for FI, 2.1 (0.6) for HI (p < 0.01 v FI), and 2.6 (0.4) for TOE (p < 0.001 v HI). The association between FI and TOE findings was Phi = 0.35 (chi2 = 17.57, p = 0.0014) and between HI and TOE it was Phi = 0.95 (chi2 = 125.72, p < 0.0001; p < 0.0001 v FI). The global echo score of vegetations was 7.1 (3.3) with FI, 8.5 (3.4) with HI, and 11.3 (3.9) with TOE (p < 0.001 v HI). Compared with TOE, FI identified only one of seven abscesses (sensitivity 14%) and HI identified two of seven abscesses (sensitivity 28%).
  
  
  CONCLUSIONS
  HI provides an accurate assessment of suspected IE. TOE achieves superior definition of IE related abnormalities.
authors.affiliation: Department of Cardiology, Ca' Foncello Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy. fchirillo@ulss.tv.it
authors.forename: F
authors.initials: F
authors.lastname: Chirillo
authors.forename: A
authors.initials: A
authors.lastname: Pedrocco
authors.forename: A
authors.initials: A
authors.lastname: De Leo
authors.forename: A
authors.initials: A
authors.lastname: Bruni
authors.forename: O
authors.initials: O
authors.lastname: Totis
authors.forename: P
authors.initials: P
authors.lastname: Meneghetti
authors.forename: P
authors.initials: P
authors.lastname: Stritoni
mesh_terms: D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging*; D005260:Female; D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity