Negative predictive value of multiplane transesophageal echocardiography in the diagnosis of infective endocarditis

The clinical implications of a negative multiplane transesophageal echocardiography (TEE) have not yet been reported. We aim to determine the negative predictive value (NPV) of a negative multiplane TEE in patients with suspected infective endocarditis (IE).

We identified 83 consecutive patients with suspected IE and negative multiplane TEE from our echocardiographic database. Of 74 patients with a minimum of 1-month follow-up, only 1 patient developed "definite IE". Eight patients had "possible IE". The calculated NPV of multiplane TEE in IE was 98.6% if we only considered the case of "definite IE". If we assumed that all patients with "possible IE" had the disease, then the NPV of multiplane TEE was 87.8%.

Multiplane TEE is a highly accurate diagnostic tool with excellent NPV in IE. However, in a highly suspicious clinical setting for IE, a repeat TEE is still recommended to assess evolving echocardiographic features.