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Transthoracic versus transesophageal echocardiography for detection of Libman-Sacks endocarditis: a randomized

Carlos A Roldan1, Clifford R Qualls, Karen S Sopko

  • 1Department of Internal Medicine and Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA. carlos.roldan2@med.va.gov

The Journal of Rheumatology
|December 19, 2007
PubMed

Insights

Transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for detecting Libman-Sacks endocarditis in systemic lupus erythematosus (SLE) patients. TEE offers better accuracy and should be considered the primary diagnostic tool for suspected cases.

Area of Science:

  • Cardiology
  • Rheumatology
  • Medical Imaging

Background:

  • Libman-Sacks endocarditis (LSE) is a serious complication in systemic lupus erythematosus (SLE) patients, leading to thromboembolism, severe valve dysfunction, and increased mortality.
  • Transesophageal echocardiography (TEE) is known for its high accuracy in diagnosing valvular heart disease.

Purpose of the Study:

  • To compare the diagnostic accuracy of transthoracic echocardiography (TTE) and TEE in detecting LSE in SLE patients.
  • To evaluate the effectiveness of TEE versus TTE in identifying LSE-related valve abnormalities.

Main Methods:

  • Eighty-one SLE patients and 75 healthy controls underwent paired TTE and TEE examinations.
  • Both echocardiographic modalities were assessed for valve vegetations, thickening, and regurgitation severity.
  • Studies were randomized and interpreted by an experienced observer blinded to patient data.

Main Results:

  • LSE was significantly more prevalent in SLE patients than controls, detected by both TTE and TEE (p < 0.001).
  • TEE detected LSE more frequently than TTE (p ≤ 0.05), with poor agreement between the two methods (kappa 0.02-0.54).
  • Compared to TEE, TTE showed low sensitivity (63%), specificity (58%), and negative predictive value (40%) for LSE detection.

Conclusions:

  • Transesophageal echocardiography (TEE) demonstrates superior diagnostic performance over transthoracic echocardiography (TTE) for LSE in SLE patients.
  • TEE should be considered as an initial diagnostic test or a complement to non-diagnostic TTE in SLE patients with suspected LSE or related complications.
Abstract

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