title: Three-dimensional compared to two-dimensional transesophageal echocardiography for diagnosis of infective endocarditis.
abstract: OBJECTIVE
  Transesophageal echocardiography is crucial for the diagnosis of infective endocarditis (IE). Use of three-dimensional transesophageal echocardiography (3D-TEE) could improve the reliability of echocardiographic findings. This study sought to determine the value of 3D-TEE in the diagnosis of IE in comparison to two-dimensional (2D)-TEE and 2D transthoracic echocardiography (2D-TTE).
  
  
  METHODS
  In this prospective cohort study in a tertiary care university hospital 144 consecutive patients with clinically suspected IE were included. The patients were subjected to clinical, microbiological and echocardiographic evaluation (2D-TTE, 2D-TEE and 3D-TEE) and their clinical history evaluated retrospectively to establish a reference diagnosis of IE in accordance to current guideline recommendations.
  
  
  RESULTS
  In 48 (33 %) patients the diagnosis of IE was established. 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 94 % and 63, 90 and 95 %, 82 and 86 % and 97 and 83 %, respectively, with similar results in patients with native and prosthetic valves. Vegetations and abscess were detected in 43 and 5 patients with final diagnosis of IE by any of the assessed echocardiographic modalities, with only one case of vegetation detected by 3D-TEE only and not by 2D-TEE.
  
  
  CONCLUSIONS
  In this cohort of patients with suspected IE, 3D-TEE showed substantial lower sensitivity and negative predictive value for diagnosis of IE when compared to 2D-TEE. 3D-TEE might provide additive diagnostic information with impact on clinical decisions only in individual cases.
authors.affiliation: Department III of Internal Medicine, Heart Centre of the University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany. roman.pfister@uk-koeln.de.
authors.forename: Roman
authors.initials: R
authors.lastname: Pfister
authors.affiliation: Department III of Internal Medicine, Heart Centre of the University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Yann
authors.initials: Y
authors.lastname: Betton
authors.affiliation: Department III of Internal Medicine, Heart Centre of the University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Henrik Ten
authors.initials: HT
authors.lastname: Freyhaus
authors.affiliation: Department I of Internal Medicine, University of Cologne, Cologne, Germany.
authors.forename: Norma
authors.initials: N
authors.lastname: Jung
authors.affiliation: Department III of Internal Medicine, Heart Centre of the University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Department III of Internal Medicine, Heart Centre of the University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Michels
mesh_terms: D000368:Aged; D019560:Echocardiography, Three-Dimensional / Q000706:statistics & numerical data*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Echocardiography; Infective endocarditis; Three-dimensional echocardiography; Transesophageal echocardiography