Abstract 18332: Diagnostic Yield of Transesophageal Echocardiography for Infective Endocarditis in Patients Referred for Suspected Endocarditis
Background: The expert panel that authored the 2011 Appropriate Use Criteria for Echocardiography considered the use of transesophageal echocardiography (TEE) to be appropriate when used to diagnose infective endocarditis (IE) with a moderate or high pretest probability. The panel appropriate use score was 9, the highest possible score achievable. Few published data are currently available to support this recommendation. We aimed to define the diagnostic yield of TEE in a population with moderate or high pretest probability for IE.
Methods: Consecutive TEE reports (n=6,189) acquired between 1/1/2005 and 12/31/2012 at our institution were reviewed for the presence of possible or definite endocarditis. TEE were acquired from 5,347 individual patients. Endocarditis was considered to be present if a new vegetation was demonstrated or there was obvious abscess formation. The diagnostic yield for endocarditis was compared between exams performed for different indications.
Results: The study group was 62 ± 15 years old and 55% male. Most TEE (78%) were performed on inpatients. TEE findings are reported in the Table. The yields for definite and possible IE were 9% and 8% respectively amongst subjects with bacteremia referred for suspected IE. Those referred for suspected IE had increased odds for finding definite IE (odds ratio (OR) 4.2, 95% CI: 2.7, 6.6, p<0.001). Amongst those referred for suspected IE, prosthetic valve (OR 2.4, 95% CI: 1.5, 3.8, p<0.001) and pacemaker/ICD (OR 16, 95% CI: 6, 44, p<0.001) were independent predictors of definite IE.
Conclusion: The diagnostic yield for finding IE on TEE in subjects with bacteremia referred for suspected IE is reasonably high. Our findings support the current recommendations for use of TEE in this population.
- © 2013 by American Heart Association, Inc.