Echocardiographic detection of cardiac valve vegetations and prognostic implications

Echocardiography is a well-established method for diagnosis of vegetations in patients with infective endocarditis. The sensitivity for detection of valvular vegetations depends on the technique used (M-mode, 2D) and is highest for the transesophageal approach (above 90%). Transesophageal echocardiography has been very helpful in patients with suspected endocarditis but a negative transthoracic echocardiogram, and in patients with suspected pulmonary and prosthetic valve endocarditis. Specificity of echocardiography is relatively low in unselected patients, but echocardiography has a high diagnostic yield in preselected patients with clinically suspected active endocarditis. Besides the visualization of vegetations, echocardiography (including Doppler) is the method of choice in the diagnosis of endocarditis-associated complications, e.g., valvular destruction with subsequent severe regurgitation, secondary "jet" or "kissing" lesions, and paravalvular abscesses. The diagnostic power of echocardiography in the detection of paravalvular abscesses and abscess-related complications has been substantially improved with the transesophageal approach. In addition, echocardiographic findings may have prognostic implications. The size and mobility of vegetations stratifies endocarditis patients into a high-risk group for arterial embolism. Furthermore, increase in size of vegetations during antimicrobial treatment may identify patients with no, or at least a prolonged, healing process. Thus, echocardiography has an important diagnostic and prognostic impact in patients with infective endocarditis and is today an established adjacent technique to clinical findings and blood cultures.