[Transesophageal echocardiography and endocarditis]

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Endocarditis diagnosis relies heavily on imaging, with transthoracic echocardiography (TTE) being a primary tool.
• However, TTE's diagnostic accuracy can be limited in certain cases, necessitating further investigation.

Purpose of the Study:

• To compare the diagnostic and therapeutic efficacy of transesophageal echocardiography (TEE) versus TTE in patients with suspected or confirmed endocarditis.
• To evaluate the ability of each modality to detect endocarditis-related complications.

Main Methods:

• A comparative study involving 49 patients with 51 episodes of suspected endocarditis.
• Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed.
• Diagnosis was confirmed by operation, autopsy, or clinical course.

Main Results:

• Transesophageal echocardiography (TEE) achieved a correct diagnosis in 85% of cases, significantly higher than TTE's 37% (p < 0.05).
• TEE reduced ambiguous results from 58% (TTE) to 13%.
• TEE identified all 14 endocarditis complications (e.g., cavity formation, fistulae rupture, perivalvular leakage), compared to 21% by TTE. Treatment was changed in 39% of patients after TEE.

Conclusions:

• Transesophageal echocardiography (TEE) provides significantly greater diagnostic certainty for endocarditis than TTE.
• TEE substantially decreases ambiguous findings and improves the detection of critical complications.
• TEE is recommended when TTE is inconclusive for clinically suspected endocarditis.