Three-dimensional compared to two-dimensional transesophageal echocardiography for diagnosis of infective endocarditis.

Abstract

Transesophageal echocardiography is crucial for the diagnosis of infective endocarditis (IE). Use of three-dimensional transesophageal echocardiography (3D-TEE) could improve the reliability of echocardiographic findings. This study sought to determine the value of 3D-TEE in the diagnosis of IE in comparison to two-dimensional (2D)-TEE and 2D transthoracic echocardiography (2D-TTE). In this prospective cohort study in a tertiary care university hospital 144 consecutive patients with clinically suspected IE were included. The patients were subjected to clinical, microbiological and echocardiographic evaluation (2D-TTE, 2D-TEE and 3D-TEE) and their clinical history evaluated retrospectively to establish a reference diagnosis of IE in accordance to current guideline recommendations. In 48 (33%) patients the diagnosis of IE was established. 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 94% and 63, 90 and 95%, 82 and 86% and 97 and 83%, respectively, with similar results in patients with native and prosthetic valves. Vegetations and abscess were detected in 43 and 5 patients with final diagnosis of IE by any of the assessed echocardiographic modalities, with only one case of vegetation detected by 3D-TEE only and not by 2D-TEE. In this cohort of patients with suspected IE, 3D-TEE showed substantial lower sensitivity and negative predictive value for diagnosis of IE when compared to 2D-TEE. 3D-TEE might provide additive diagnostic information with impact on clinical decisions only in individual cases.