Analysis of Transesophageal Echocardiography Appropriateness for Diagnosing Infective Endocarditis: Insights from Two Tertiary Care Hospitals

Abstract

BackgroundEchocardiography plays a key role in the diagnosis of infective endocarditis (IE), with published recommendations regarding the appropriate use of transesophageal echocardiogram (TEE). The objective of this study is to evaluate the utilization of TEE in Regina, Saskatchewan, in the diagnosis of IE. MethodsA retrospective chart review was performed on patients aged ≥ 18 years who received a TEE for the diagnosis of IE from January 1 to December 31, 2019. Primary outcome included the proportion of TEEs that complied with ACCF/ASE and ESC recommendations. ResultsThere were 204 admissions involving 188 patients who had a TEE performed for the diagnosis of IE within the study period. The mean age was 53.1 ± 17.1 years. Of the 204 TEEs, 152 (74.5%) were considered appropriate by the ACCF/ASE recommendations. Patients who had at least one predisposing condition (aOR 4.30 (95% CI 2.11-9.04), p < 0.001)) were more likely to be associated with appropriate TEE use by ACCF/ASE criteria. Of the 204 TEEs, only 80 (39.2%) were considered appropriate by the ESC recommendations. Patients who had a history of intravenous drug use (aOR 3.08 (95% CI 1.08-9.27), p = 0.04)) and blood cultures positive for IE-related organisms (aOR 2.31 (95% CI 1.16-4.80), p = 0.02)) were more likely associated with appropriate TEE use by ESC recommendations. ConclusionsThe current study suggested that the use of TEE in the diagnosis of IE demonstrated variable adherence to published recommendations by ACCF/ASE and ESC, with significant discrepancy between the two.