Real-World Diagnostic Performance of Repeat Transthoracic Echocardiography Within a Multimodality Imaging Approach in...

Area of Science:

• Cardiology
• Infectious Diseases
• Diagnostic Imaging

Background:

• Echocardiography is crucial for diagnosing infective endocarditis (IE).
• Guidelines suggest repeating echocardiography if clinical suspicion for IE persists despite inconclusive initial findings.
• The diagnostic value of repeat transthoracic echocardiography (TTE) for IE is not well-established.

Purpose of the Study:

• To evaluate the diagnostic performance of repeat TTE in diagnosing IE among patients with suspected IE.
• To assess the incremental value of a second TTE in the diagnostic workup of suspected IE.

Main Methods:

• Retrospective study at Lausanne University Hospital (2015-2024).
• Included adult patients with suspected IE who underwent two TTEs within 21 days.
• IE classification followed the 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria.

Main Results:

• 503 IE episodes were analyzed; 50% were diagnosed with IE.
• The second TTE, performed within 8 days of the first, identified new vegetations in 7% and new paravalvular complications in 3%.
• Sensitivity for vegetation detection increased from 47% (first TTE) to 57% (second TTE); however, the second TTE's standalone sensitivity for IE diagnosis was 45% compared to 34% for the first.

Conclusions:

• Repeat TTE modestly improved the detection of typical IE lesions.
• The incremental diagnostic contribution of repeat TTE within a multimodality imaging strategy was limited.
• Repeated TTE alone is unlikely to significantly alter IE diagnosis in most cases, supporting the use of complementary imaging when suspicion remains high.