Related Experiment Video
Updated: Oct 25, 2025
Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
Restricted Use of Echocardiography in Suspected Endocarditis during COVID-19 Lockdown: A Multidisciplinary Team
Adam Hartley1,2, Ahmed El-Sayed2, Aula Abbara2
1National Heart and Lung Institute, Imperial College London, London, UK.
Insights
Managing infective endocarditis (IE) during COVID-19 lockdowns is difficult. Utilizing an endocarditis team (ET) to limit echocardiography, including transesophageal echocardiography (TOE), did not impact diagnostic accuracy or mortality in suspected IE cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Infective endocarditis (IE) management is complicated by COVID-19 restrictions, particularly concerning echocardiography and virus transmission risks.
- This study investigated the role of the endocarditis team (ET) in reducing routine echocardiography, especially transesophageal echocardiography (TOE), during the pandemic.
- The impact of these changes on clinical outcomes for patients with suspected IE was explored.
Purpose of the Study:
- To assess the utilization of the endocarditis team (ET) in limiting echocardiography for suspected infective endocarditis (IE) during COVID-19 lockdown.
- To explore the effect of restricted echocardiography on the diagnostic capabilities of the Modified Duke Criteria.
- To determine the impact of ET-guided echocardiography restriction on all-cause mortality in patients with suspected IE.
Main Methods:
- An observational study was conducted at Imperial College Healthcare NHS Trust during the UK's first COVID-19 lockdown (March 23–July 8, 2020).
- All patients discussed at the endocarditis team (ET) meeting during this period were prospectively included.
- Data on echocardiography utilization and clinical outcomes were collected and analyzed.
Main Results:
- 38 patients with suspected IE were reviewed by the ET; 21% had no echo, 16% had point-of-care ultrasound only, and 63% had transthoracic echocardiography (TTE).
- Only 16% of patients underwent transesophageal echocardiography (TOE).
- While echocardiography significantly aided IE diagnosis (p=0.0099), sensitivity was unaffected. All-cause mortality was 17% at 30 days and 25% at 12 months for confirmed IE cases.
Conclusions:
- Restricting echocardiography in patients with low pretest probability for IE did not compromise the diagnostic ability of the Modified Duke Criteria to rule out IE.
- The use of the endocarditis team (ET) to limit nonessential echocardiography, including TOE, did not negatively impact all-cause mortality in suspected IE patients.
- ET guidance can help optimize echocardiography use in suspected IE during public health crises without adversely affecting patient outcomes.
Background:
Infective endocarditis (IE) is challenging to manage in the COVID-19 lockdown period, in part given its reliance on echocardiography for diagnosis and management and the associated virus transmission risks to patients and healthcare workers. This study assesses utilisation of the endocarditis team (ET) in limiting routine echocardiography, especially transoesophageal echocardiography (TOE), in patients with suspected IE, and explores the effect on clinical outcomes.
Methods:
All patients discussed at the ET meeting at Imperial College Healthcare NHS Trust during the first lockdown in the UK (23 March to 8 July 2020) were prospectively included and analysed in this observational study.
Results:
In total, 38 patients were referred for ET review (71% male, median age 54 [interquartile range 48, 65.5] years). At the time of ET discussion, 21% had no echo imaging, 16% had point-of-care ultrasound only, and 63% had formal TTE. In total, only 16% underwent TOE. The ability of echocardiography, in those where it was performed, to affect IE diagnosis according to the Modified Duke Criteria was significant (p=0.0099); however, sensitivity was not affected. All-cause mortality was 17% at 30 days and 25% at 12 months from ET discussion in those with confirmed IE.
Conclusion:
Limiting echocardiography in patients with a low pretest probability (not probable or definite IE according to the Modified Duke Criteria) did not affect the diagnostic ability of the Modified Duke Criteria to rule out IE in this small study. Moreover, restricting nonessential echocardiography, and importantly TOE, in patients with suspected IE through use of the ET did not impact all-cause mortality.
Related Concept Videos
01:18Endocarditis III: Medical Management
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:29Endocarditis IV: Nursing Management
01:25Endocarditis I: Introduction
01:25Endocarditis II: Clinical Features of Infective Endocarditis