Abstract 730: The Incremental Value of Real-Time 3-Dimensional Transesophageal Echocardiography in the Evaluation of Intracardiac Wire Related Infective Endocarditis
BACKGROUND Echocardiography is essential in the diagnosis of infective endocarditis (IE). Although transthoracic echocardiography (TTE) has a relatively high specificity for detecting vegetations, 2-dimensional transesophageal echocardiography (TEE) is frequently performed to improve sensitivity. However, evaluating IE in patients with intracardiac (IC) wires remains a challenge. IC wires traverse multiple planes and cardiac chambers and create significant reverberations and shadowing artifacts, which limit visualization. Although TEE improves imaging, artifacts and poor wire localization often remain. The recent development of real-time 3-dimensional transesophageal echocardi-ography (RT3DTEE) allows high quality images in several cardiac planes to be obtained simultaneously. We evaluated the incremental value and possible role of RT3DTEE in the evaluation and diagnosis of IC wire related IE.
METHODS Twenty consecutive studies in patients with clinically diagnosed IC related IE who had TTE, TEE, and RT3DTEE, were identified. IC wire related IE was defined by the Duke criteria for IE and shaggy mobile echodensities located on IC wires. All studies were read by 2 separate echocardiographers and evaluated for whether vegetations could be seen on IC wires on TTE, TEE, and/or RT3DTEE.
RESULTS TTE had the lowest sensitivity in the identification of vegetations on IC wires as it was diagnostic in only 8 out of 20 studies (40%). TEE had significantly increased sensitivity; vegetations on IC wires were seen in 15 out of 20 studies (75%). RT3DTEE improved TEE’s sensitivity as it confirmed vegetations on 1 equivocal TEE study and also identified 4 additional studies with IC wire vegetations, not seen on TEE. In 3 cases where TEE was non-diagnostic, more than 2 IC wires were seen within the heart. IC wire vegetations were seen on RT3DTEE in all 20 cases. Additionally, localization (e.g., atrial vs. ventricular wires), attachment, and size of the IC wire vegetations were better characterized on RT3DTEE as compared to TEE.
CONCLUSION RT3DTEE improves the sensitivity in the identification of vegetations in IC wire related IE. Our study suggests a possible role for RT3DTEE, in the evaluation of IC wire related IE, especially in patients with more than 2 IC wires.