Inaccuracy of transthoracic echocardiography for the identification of right-sided vegetation in patients with no history of intravenous drug abuse or cardiac device insertion.
OBJECTIVE
The use of transthoracic echocardiography (TTE) to identify right-sided infective endocarditis (RSIE) vegetation is controversial. Data are scarce for patients with no history of intravenous drug abuse (IVDA) or cardiac device insertion. This study analysed the consistency of presurgical echocardiographic results with surgical findings for vegetation identification, and the factors that influence accuracy of echocardiography.


METHODS
This retrospective trial divided infective endocarditis (IE) patients into three subgroups according to the results of their presurgical TTE: left-sided native IE (LSNIE), left-sided prosthetic valve IE (LSPIE) and RSIE. The accuracy of TTE was tested by comparing vegetation (number and location), detected presurgery by TTE, with actual findings during surgery.


RESULTS
In total, 416 patients were analysed, 322 with LSNIE, 31 with LSPIE and 63 with RSIE. Consistency between TTE findings and surgical results was lower in the RSIE group compared with the LSPIE and LSNIE groups. Consistency was lowered by the presence of vegetation in multiple locations and atypical distribution--both of which were increased in the RSIE group. The chance of vegetation in both sides of the heart rose with increased numbers of vegetation locations in RSIE patients. A high proportion of RSIE patients had congenital heart defects, mostly ventricular septal defects.


CONCLUSIONS
TTE may be unsuitable for RSIE patients with no history of IVDA or cardiac device insertion, because multifocal and atypically distributed vegetation may influence detection accuracy.
Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Jiang
J
Xie
Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China liushuangmedsci@163.com.
Shuang
S
Liu
Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Jinghua
J
Yang
Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Jie
J
Xu
Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Guangfa
G
Zhu
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D062906:Cardiac Catheters; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000706:statistics & numerical data*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D005189:False Positive Reactions; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D006346:Heart Septum / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000382:microbiology / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000382:microbiology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous
D000900:Anti-Bacterial Agents
Transthoracic echocardiography; congenital heart disease; right-sided infective endocarditis; vegetation