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[Transesophageal echocardiography and endocarditis]
J Tingleff1, H Egeblad, U Abildgaard
1Thoraxkirurgisk afdeling, Rigshospitalet, København.
Insights
Transesophageal echocardiography (TEE) significantly improves endocarditis diagnosis and complication detection compared to transthoracic echocardiography (TTE). TEE offers greater certainty and reduces ambiguous results, aiding critical treatment decisions in suspected endocarditis cases.
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.
Abstract:
In 49 patients (34 men and 15 women with an average age of 51 years, range 21-81 years) with a total of 51 episodes of suspected or already demonstrated endocarditis, the diagnostic and therapeutic value of transthoracic echocardiography (TTE) was compared with transoesophageal echocardiography (TEE). It was demonstrated by operation, autopsy, or the course of the condition, that endocarditis was present in 34 cases, while 17 patients did not have endocarditis. The correct diagnosis was established in 19 out 51 cases (37%) by TTE and in 44 (85%) cases by TEE (p < 0.05). The number of ambiguous investigation results fell significantly from 30 (58%) with TTE to seven with TEE. A total of 14 cases of cavity formation related to endocarditis, rupture of fistulae, or perivalvular leakage from prostheses occurred. Three (21%) of these complications were demonstrated by TTE while TEE demonstrated all 14. After examination with TEE, treatment of the patients was changed in 20 cases (39%). It is concluded that: 1) TEE can confirm or exclude the diagnosis of endocarditis with much greater certainty than TTE, 2) TEE more than halves the number of ambiguous results of investigation and 3) TEE multiplies recognition of complications of endocarditis. Even although the results from the cardiological/thoracic surgical centre cannot be transferred to the primary hospital just like that, the results of these and other investigations suggest that TEE should be carried out when TTE cannot confirm or exclude clinically suspected endocarditis with certainty.(ABSTRACT TRUNCATED AT 250 WORDS)