title: The potential impact of contemporary transthoracic echocardiography on the management of patients with native valve endocarditis: a comparison with transesophageal echocardiography.
abstract: BACKGROUND
  Between 1987 and 1994, several studies demostrated transthoracic echocardiography (TTE) to be less sensitive than transesophageal echocardiography (TEE) in detecting native valve endocarditis. Recent technologic advances, especially the introduction of harmonic imaging and digital processing and storage, have improved TTE image quality. The aim of this study was to determine the diagnostic accuracy of contemporary TTE.
  
  
  METHODS
  Between 2003 and 2007, 75 patients underwent both TTE and TEE for clinically suspected infective endocarditis. The diagnostic accuracy of TTE was assessed using transesophageal echocardiography as the gold standard for diagnosis of endocarditis.
  
  
  RESULTS
  Of the 75 patients in this study, 33 were found to be positive by TEE. The sensitivity for detection of infective endocarditis by TTE was 81.8%. It provided good image quality in 81.5% of cases; in these patients sensitivity was even greater (89.3%).
  
  
  CONCLUSIONS
  Contemporary TTE has improved the diagnostic accuracy of infective endocarditis by ameliorating image quality; it provides an accurate assessment of endocarditis and may reduce the need for TEE.
authors.affiliation: Department of Cardiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Casella
authors.forename: Bushra
authors.initials: B
authors.lastname: Rana
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casazza
authors.forename: Amit
authors.initials: A
authors.lastname: Bhan
authors.forename: Stam
authors.initials: S
authors.lastname: Kapetanakis
authors.forename: Joe
authors.initials: J
authors.lastname: Omigie
authors.forename: Joseph
authors.initials: J
authors.lastname: Reiken
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Monaghan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004696:Endocarditis / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity