Appropriate Use of Transesophageal Echocardiogram for Infective Endocarditis: A Single Center Experience

Area of Science:

• Cardiology
• Diagnostic Imaging
• Medical Quality Improvement

Background:

• Transesophageal echocardiogram (TEE) is a key diagnostic tool, offering detailed cardiac visualization.
• The American Society of Echocardiography (ASE) established appropriate use criteria to optimize TEE utilization.
• This study assessed TEE adherence to ASE criteria in infective endocarditis workups.

Purpose of the Study:

• To evaluate the appropriateness of Transesophageal echocardiogram (TEE) use in diagnosing infective endocarditis.
• To assess adherence to American Society of Echocardiography (ASE) appropriate use criteria.
• To identify areas for improving TEE utilization in clinical practice.

Main Methods:

• Retrospective chart review of 50 Transesophageal echocardiograms (TEEs) performed for endocarditis indication in 2017.
• Analysis included TEE findings, preceding transthoracic echocardiogram (TTE) quality, cardiology consultation, and Duke criteria adherence.
• Assessment of TEEs against American Society of Echocardiography (ASE) appropriate use criteria.

Main Results:

• Only 56% of Transesophageal echocardiograms (TEEs) met appropriate use criteria.
• Evidence of infection was found in only 36% of TEEs.
• Pre-TEE transthoracic echocardiogram quality was suboptimal in a significant portion of cases, and cardiology consultation was absent in 20%.

Conclusions:

• Adherence to American Society of Echocardiography (ASE) appropriate use criteria for Transesophageal echocardiogram (TEE) in endocarditis diagnosis was suboptimal.
• Increased awareness and education on ASE guidelines are necessary to reduce unnecessary procedures.
• Optimizing TEE use can minimize patient risks and healthcare costs.