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Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass
Robert Sogomonian1, Hassan Alkhawam2, Neil Vyas2
1Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA; Robert.sogomonian@mssm.edu.
Insights
For infective endocarditis diagnosis, transthoracic echocardiography (TTE) is less sensitive in patients with a higher body mass index (BMI ≥25 kg/m²). Transesophageal echocardiography (TEE) may be a more appropriate initial diagnostic tool for these patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Echocardiography is crucial for diagnosing infective endocarditis (IE) using modified Duke criteria.
- The diagnostic utility of transthoracic echocardiography (TTE) versus transesophageal echocardiography (TEE) in patients with varying body mass index (BMI) requires evaluation.
Purpose of the Study:
- To assess the necessity of TTE versus TEE for IE diagnosis based on patient BMI.
- To determine the optimal echocardiographic modality for IE diagnosis in patients with BMI <25 kg/m² and BMI ≥25 kg/m².
Main Methods:
- Retrospective analysis of 198 patients diagnosed with IE (modified Duke criteria) between 2005-2012.
- Inclusion criteria: age >18, echocardiogram, and blood cultures.
- Comparison of TTE and TEE findings, including sensitivity and specificity, stratified by BMI (<25 kg/m² and ≥25 kg/m²).
Main Results:
- Overall TTE sensitivity was 67% and specificity 93%.
- In patients with BMI ≥25 kg/m², TTE sensitivity was 54% and specificity 92%.
- In patients with BMI <25 kg/m², TTE sensitivity was 78% and specificity 95%.
Conclusions:
- For patients with BMI <25 kg/m² and a negative TTE, further studies may not be needed; TEE use warrants clinical judgment.
- For patients with BMI ≥25 kg/m², TEE may be the preferred initial diagnostic study to avoid unnecessary TTE.
Background:
Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE) with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) in patients with a body mass index (BMI) greater than or equal to 25 kg/m(2) and less than 25 kg/m(2).
Methods:
A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study.
Results:
Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65%) were discovered to have native valve vegetations on TEE and 58 (35%) with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m(2) and the subsequent group with a BMI <25 kg/m(2). Patients with a BMI ≥25 kg/m(2) who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m(2) had a TTE sensitivity and specificity of 78 and 95%, respectively.
Conclusions:
Patients with a BMI <25 kg/m(2) and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m(2) may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE.
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