Abstract 13381: Utility of Transthoracic Echocardiogram in Diagnosing Native Valve Infective Endocarditis

Abstract

Background: Infective endocarditis (IE) predisposes patients to severe morbidity and mortality. 2D transthoracic echocardiogram (TTE) is the preferred initial imaging modality of choice and frequently is followed by Transesophageal echocardiogram (TEE). Establishing the role of TTE and a TEE in ruling out IE can provide a framework for institutional changes leading to fewer invasive and costly TEE procedures. Methods: A retrospective chart review at the University of New Mexico Hospitals included patients diagnosed with IE for which echocardiography was performed. Demographic data, history of IV drug use, prior IE, physical exam findings, microbiology, echocardiographic findings, and post-imaging management changes were recorded. Results: We identified 101 patients with clinically suspected endocarditis for review. TTE was performed in all patients and TEE in 23 patients (23%). TTE results were positive for endocarditis in 11 patients (10.89%), negative in 83 patients (82.18%), and indeterminate in 6 patients (5.94%) and did not have surgical features. TEE was performed in 4 out of 11 patients with positive TTE. TEE did not change management in these cases. In the 6 cases of indeterminate TTE, treatment decisions could be made in 4 cases without a TEE. Two of the 101 patients had negative TTE but positive TEE. Both had MSSA bacteremia and a positive Duke score. TEE resulted in a longer antibiotic course. Treatment decisions could be made in 78% of patients with suspected infective endocarditis without a TEE. Conclusion: TEE has a small added value for the diagnosis of infective endocarditis, and treatment decisions can often be made in most patients without the use of TEE. In this study, TEE only changed care in 2% of patients with suspected IE without surgical features by increasing the duration of antibiotic treatment.