title: Usefulness of intracardiac echocardiography for the diagnosis of cardiovascular implantable electronic device-related endocarditis.
abstract: OBJECTIVE
  The goal of this study was to compare transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) for the diagnosis of cardiac device-related endocarditis (CDI).
  
  
  BACKGROUND
  The diagnosis of infective endocarditis (IE) was established by using the modified Duke criteria based mainly on echocardiography and blood culture results. No previous studies have compared ICE with TEE for the diagnosis of IE.
  
  
  METHODS
  We prospectively enrolled 162 patients (age 72 ± 11 years; 125 male) who underwent transvenous lead extraction: 152 with CDI and 10 with lead malfunction (control group). Using the modified Duke criteria, we divided the patients with infection into 3 groups: 44 with a "definite" diagnosis of IE (group 1), 52 with a "possible" diagnosis of IE (group 2), and 56 with a "rejected" diagnosis of IE (group 3). TEE and ICE were performed before the procedure.
  
  
  RESULTS
  In group 1, ICE identified intracardiac masses (ICM) in all 44 patients; TEE identified ICM in 32 patients (73%). In group 2, 6 patients (11%) had ICE and TEE both positive for ICM, 8 patients (15%) had a negative TEE but a positive ICE, and 38 patients (73%) had ICE and TEE both negative. In group 3, 2 patients (3%) had ICM both at ICE and TEE, 1 patient (2%) had an ICM at ICE and a negative TEE, and 53 patients (95%) had no ICM at ICE and TEE. ICE and TEE were both negative in the control group.
  
  
  CONCLUSIONS
  ICE represents a useful technique for the diagnosis of ICM, thus providing improved imaging of right-sided leads and increasing the diagnostic yield compared with TEE.
authors.affiliation: Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. lianarducci@yahoo.it
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Narducci
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.forename: Leonardo
authors.initials: L
authors.lastname: Marinaccio
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Monaco
authors.forename: Francesco
authors.initials: F
authors.lastname: Perna
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bencardino
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Palmieri
authors.forename: Christian
authors.initials: C
authors.lastname: Lauria
authors.forename: Ghaliah
authors.initials: G
authors.lastname: Al Mohani
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Clemente
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
authors.forename: Faustino
authors.initials: F
authors.lastname: Pennestri
authors.forename: Carolina
authors.initials: C
authors.lastname: Ierardi
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Rebuzzi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000382:microbiology; D017548:Echocardiography, Transesophageal; D004567:Electrodes, Implanted / Q000009:adverse effects* / Q000382:microbiology; D004696:Endocarditis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology; D012720:Severity of Illness Index