Abstract
Detection of infective endocarditis (IE) remains a diagnostic challenge. Current guidelines recommend initial evaluation with transthoracic echocardiogram (TTE) with subsequent transesophageal echocardiogram (TEE) if the pre-test probability of IE is intermediate or high. The low reported sensitivity of TTE for detection of IE is based on studies using less advanced echo techniques than are available today, and do not take into account TTE quality. More recent evidence suggests that image quality of TTE may greatly impact the negative predictive value (NPV) of TTE for ruling out native valve vegetations. A good quality TTE may be sufficient to rule out IE in the absence of high risk clinical features.
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