Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis

Abstract

To compare the diagnostic value of transesophageal and transthoracic echocardiography in Infective endocarditis, paired transesophageal and transthorecic echocardiograms were obtained prospectively for 66 episodes of suspected endocarditis in 62 patients. Echocardiographic results were compared with the presence or absence of endocarditis determined by pathologic or nonechocardiograpric data from the subsequent clinical course. All echocardiograms were interpreted by an observer told only that the studies were from patients in whom the diagnosis of endocarditis was suspected.The diagnotis of endocarditis was eventually made in 16 of ihe 66 episodes of suspecrted endocarditis (14 by pathologic and 2 by clinical criteria). In 7 of 16 transthoracic and 15 of 16 transesophageal echeocardiograms, endocarditis was diagnosed at a probability level of “almost certain,” giving a sensitivity of 44% and 94%, respectively (p < 0.01). For the remaining episodes, 49 of 50 transthoracic and all transesophageal studies yielded normal results, giving a specificity of 98% and 100%, respectively.This study suggests that transesophageal echocardiography is highly sensitive and specific for the diagnosis of infective endocarditis and significantly more sensitive than transthoracic echocardiography. Although echocardiography camot rule out endocarditis, the high diagnostic sensitivity of transesophageal echocardiography results in a low probability of the disease when the studt yields negative results in a patient with an intermediate likelihood of the disease.