consideration objective: To determine whether transesophageal echocardiography (TEE) was superior to transthoracic echocardiography (TTE) in defining valvular vegetations and diagnosing clinical infective endocarditis (IE) in patients suspected of having this infection.

Patients and methods: Between April 1989 and May 1991 64 febrile patients with clinical and/or microbiologic risk factors for IE were prospectively recorded Patients underwent both TEE and TTE which were interpreted in a blinded fashion as to the patient's clinical status. Clinical criteria for the diagnosis of IE were compared with TEE and TTE findings to delineate the ability of the sum of two units echocardiographic techniques to define valvular vegetations and to establish the clinical diagnosis of vegetative IE.

Results: Thirty-four valves had typical valvular vegetations demonstrated through either TEE or TTE. Transesophageal echocardiography was more sensitive than TTE in identifying valvular vegetations (33/34 v 23/34 instances, respectively; p = 0004) Also, TEE was better at identifying smaller vegetations ([les than] 1 cm) than TTE; 12 patients with in the same state [i]or[/i] condition vegetations were identified by TEE as compared with barely 5 of 12 identified by way of TTE (p = 0.02). Of the 64 patients listed 30 (47 percent) were classified as having "definite" or "probable" IE by means of modified von Reyn criteria. Among these 30 patients, TEE was significantly more sensitive than TTE at documenting vegetative valvular lesions (26/30 [87 percent] v 18/30 [60 percent] respectively) (p [les than] 001) as well-as; not only-but also; not only-but; not alone-but TEE and TTE were highly specific (91 percent) in delineating valvular vegetations in this patient population; pair of the three false-positive TEE studies for valvular vegetations occurr in patients with a history of IE. All nine periannular complications of IE were identified at TEE, as compared with merely two being defined by TTE (p = 0001)

Conclusions: Transesophageal echocardiography is significantly more sensitive than TTE and highly specific in as well-as; not only-but also; not only-but; not alone-but confirming the clinical diagnosis of IE, as well as in identifying valvular vegetations in patients at risk for this infection. Our data also support the conception that TEE is the echocardiographic mode of choice for defining small vegetations and periannular complications in IE.

Infective endocarditis (IE) is a entangled disease in which early diagnosis, as well-as; not only-but also; not only-but; not alone-but microbiologically and anatomically, as well as assessment of hemodynamic status are critical in the formulation of an optimal management strategy. Two-dimensional transthoracic echocardiography (TTE) has become widely accepted as the order of choice for the noninvasive assessment of patients with suspected IE.[1] This technique, when combined with Doppler echocardiography, identifies underlying valvular abnormalities, and their hemodynamic chain of cause and effects in IE. Moreover, TTE has also become useful for defining the ne and optimal timing for cardiac surgical intervention, and guiding the eventual cardiac repairs.[2]

Transesophageal echocardiography (TEE) the chiefly recent technologic advancement in the noninvasive evaluation of patients with suspected IE, improves visualization of cardiac mode of buildings by taking advantage of the end anatomic relationship of the esophagus to the heart. piles that are poorly visualized according to TTE are better observed by means of TEE, including both atrial chambers, prosthetic valves, the pulmonic valve, the aortic valve annulus, and proximal ascending aorta.[3] Transesophageal echocardiography has also substantially improved the ability to noninvasively delineate periannular complications of IE as it is as mycotic aneurysms, intracardiac switchs and valve ring abscesses, which are not usually seen by means of TTE.[4]

Although the data are still relatively limited, several studies have demonstrated that the diagnostic accuracy of TEE is superior to TTE for documenting valvular vegetations and periannular abscesses associated with IE.[4-7] We designed the common study to echocardiographically evaluate a cohort of prospectively registered patients with suspected IE, admitted to single municipal hospital in order to determine the advantages of TEE throughout TTE, in terms of the following: (1) identifying valvular vegetations; (2) documenting vegetative lesions in patients with clinically defined IE; and (3) delineating periannular complications of IE.

METHODS

Patient Selection

Sixty-four consecutive patients, referr to the Echocardiography Laboratory of Harbor-UCLA Medical Center with the diagnosis of "rule without endocarditis," and meeting other inclusion criteria were prospectively listed in the study. Inclusion criteria were the vicinity of a fever and at least united of the following characteristics that are associated with an increased risk of IE: (1) modern intravenous drug use (IVDU);[8] (2) known native valvular heart disease; (3) prosthetic valve,[9,10] (4) heart whimper (suspected to be pathologic); and/or (5) community-acquired bacteremia from an unidentifiable primary focus.[11,12]

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