Abstract
The first use of echocardiography in infective endocarditis (IE) was described in 1973. Since then, echocardiography has emerged as a major tool for the diagnosis and management of this disease. In general, transthoracic echocardiography (TTE) is adequate for diagnosing IE in cases where cardiac structures-of-interest are well visualized. Specific situations where transesophageal echocardiography is preferred over TTE include the presence of a prosthetic device, suspected periannular complications, children with complex congenital cardiac lesions, selected patients with Staphylococcus aureus bacteremia, and certain pre-existing valvular abnormalities that make TTE interpretation problematic (eg, calcific aortic stenosis). Echocardiography is also useful for risk stratification. Evidence suggests that vegetation size can predict embolic complications, although the data are inconsistent. Careful clinical assessment is essential to the proper use of echocardiography in diagnosing IE, visualizing complications related to IE, and evaluating candidacy for surgical intervention.
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References and Recommended Reading
Osler W: Gulstonian lectures on malignant endocarditis. Lecture I. Lancet 1885, 1:415–418.
Dillon JC, Feigenbaum H, Konecke LL, et al.: Echocardiographic manifestations of valvular vegetations. Am Heart J 1973, 86:698–704.
Durack DT, Lukes AS, Bright DK: New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994, 96:200–209.
Li JS, Sexton DJ, Mick N, et al.: Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000, 30:633–638.
Erbel R, Rohmann S, Drexler M, et al.: Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach. A prospective study. Eur Heart J 1988, 9:43–53.
Shapiro SM, Young E, De Guzman S, et al.: Transesophageal echocardiography in diagnosis of infective endocarditis. Chest 1994, 105:377–382.
Shively BK, Gurule FT, Roldan CA, et al.: Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol 1991, 18:391–397.
Khandheria BK: Suspected bacterial endocarditis: to TEE or not to TEE. J Am Coll Cardiol 1993, 21:222–224.
San Roman JA, Vilacosta I, Zamorano JL, et al.: Transesophageal echocardiography in right-sided endocarditis. J Am Coll Cardiol 1993, 21:1226–1230.
Mandell G, Bennett JE, Dolin R: Principles and Practice of Infectious Diseases, 6th ed. Philadelphia: Elsevier Churchill Livingston; 2005.
Daniel WG, Mugge A, Martin RP, et al.: Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med 1991, 324:795–800.
de Castro S, Cartoni D, d’Amati G, et al.: Diagnostic accuracy of transthoracic and multiplane transesophageal echocardiography for valvular perforation in acute infective endocarditis: correlation with anatomic findings. Clin Infect Dis 2000, 30:825–826.
Karalis DG, Bansal RC, Hauck AJ, et al.: Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis. Clinical and surgical implications. Circulation 1992, 86:353–362.
Shapiro SM, Young E, Ginzton LE, Bayer AS: Pulmonic valve endocarditis as an underdiagnosed disease: role of transesophageal echocardiography. J Am Soc Echocardiogr 1992, 5:48–51.
Kupferwasser LI, Darius H, Muller AM, et al.: Diagnosis of culture-negative endocarditis: the role of the Duke criteria and the impact of transesophageal echocardiography. Am Heart J 2001, 142:146–152.
Lengyel M: The impact of transesophageal echocardiography on the management of prosthetic valve endocarditis: experience of 31 cases and review of the literature. J Heart Valve Dis 1997, 6:204–211.
Rozich JD, Edwards WD, Hanna RD, et al.: Mechanical prosthetic valve-associated strands: Pathologic correlates to transesophageal echocardiography. J Am Soc Echocardiogr 2003, 16:97–100.
Birmingham GD, Rahko PS, Ballantyne F 3rd: Improved detection of infective endocarditis with transesophageal echocardiography. Am Heart J 1992, 123:774–781.
Mugge A, Daniel WG, Frank G, Lichtlen PR: Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol 1989, 14:631–638.
Rallidis LS, Komninos KA, Papasteriadis EG: Pacemaker-related endocarditis: the value of transoesophageal echocardiography in diagnosis and treatment. Acta Cardiol 2003, 58:31–34.
Victor F, De Place C, Camus C, et al.: Pacemaker lead infection: echocardiographic features, management, and outcome. Heart 1999, 81:82–87.
von Reyn CF, Levy BS, Arbeit RD, et al.: Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med 1981, 94(4 pt 1):505–518.
Kuruppu JC, Corretti M, Mackowiak P, Roghmann MC: Overuse of transthoracic echocardiography in the diagnosis of native valve endocarditis. Arch Intern Med 2002, 162:1715–1720.
Lindner JR, Case RA, Dent JM, et al.: Diagnostic value of echocardiography in suspected endocarditis. An evaluation based on the pretest probability of disease. Circulation 1996, 93:730–736.
Greaves K, Mou D, Patel A, Celermajer DS: Clinical criteria and the appropriate use of transthoracic echocardiography for the exclusion of infective endocarditis. Heart 2003, 89:273–275.
Thangaroopan M, Choy JB: Is transesophageal echocardiography overused in the diagnosis of infective endocarditis? Am J Cardiol 2005, 95:295–297.
Sochowski RA, Chan KL: Implication of negative results on a monoplane transesophageal echocardiographic study in patients with suspected infective endocarditis. J Am Coll Cardiol 1993, 21:216–221.
Heidenreich PA, Masoudi FA, Maini B, et al.: Echocardiography in patients with suspected endocarditis: a cost-effectiveness analysis. Am J Med 1999, 107:198–208.
Baddour LM, Wilson WR, Bayer AS, et al.: Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2005, 111:e394–e434.
Cheitlin MD, Alpert JS, Armstrong WF, et al.: ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997, 95:1686–1744.
Irani WN, Grayburn PA, Afridi I: A negative transthoracic echocardiogram obviates the need for transesophageal echocardiography in patients with suspected native valve active infective endocarditis. Am J Cardiol 1996, 78:101–103.
Roe MT, Abramson MA, Li J, et al.: Clinical information determines the impact of transesophageal echocardiography on the diagnosis of infective endocarditis by the Duke criteria. Am Heart J 2000, 139:945–951.
Vieira ML, Grinberg M, Pomerantzeff PM, et al.: Repeated echocardiographic examinations of patients with suspected infective endocarditis. Heart 2004, 90:1020–1024.
Fowler VG Jr, Li J, Corey GR, et al.: Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol 1997, 30:1072–1078.
El-Ahdab F, Benjamin DK Jr, Wang A, et al.: Risk of endocarditis among patients with prosthetic valves and Staphylococcus aureus bacteremia. Am J Med 2005, 118:225–229.
Sullenberger AL, Avedissian LS, Kent SM: Importance of transesophageal echocardiography in the evaluation of Staphylococcus aureus bacteremia. J Heart Valve Dis 2005, 14:23–28.
Bayer AS, Lam K, Ginzton L, et al.: Staphylococcus aureus bacteremia. Clinical, serologic, and echocardiographic findings in patients with and without endocarditis. Arch Intern Med 1987, 147:457–462.
Nolan CM, Beaty HN: Staphylococcus aureus bacteremia. Current clinical patterns. Am J Med 1976, 60:495–500.
Fowler VG Jr, Miro JM, Hoen B, et al.: Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005, 293:3012–3021.
Thuny F, Di Salvo G, Belliard O, et al.: Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation 2005, 112:69–75.
Vilacosta I, Graupner C, San Roman JA, et al.: Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol 2002, 39:1489–1495.
Di Salvo G, Habib G, Pergola V, et al.: Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001, 37:1069–1076.
de Castro S, Magni G, Beni S, et al.: Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves. Am J Cardiol 1997, 80:1030–1034.
Steckelberg JM, Murphy JG, Ballard D, et al.: Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991, 114:635–640.
Lutas EM, Roberts RB, Devereux RB, Prieto LM: Relation between the presence of echocardiographic vegetations and the complication rate in infective endocarditis. Am Heart J 1986, 112:107–113.
Rohmann S, Erbel R, Gorge G, et al.: Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. Eur Heart J 1992, 13:446–452.
Rohmann S, Erbel R, Darius H, et al.: Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size. J Am Soc Echocardiogr 1991, 4:465–474.
Manolis AS, Melita H: Echocardiographic and clinical correlates in drug addicts with infective endocarditis. Implications of vegetation size. Arch Intern Med 1988, 148:2461–2465.
Dion R: Surgery in IE: whom to operate and when; new techniques: mitral valve. Presented at the 7th International Symposium on Modern Concepts in Endocarditis and Cardiovascular Infections. Chamonix, France; June 26–28, 2003.
Rosen AB, Fowler VG Jr, Corey GR, et al.: Cost-effectiveness of transesophageal echocardiography to determine the duration of therapy for intravascular catheter-associated Staphylococcus aureus bacteremia. Ann Intern Med 1999, 130:810–820.
Lancellotti P, Galiuto L, Albert A, et al.: Relative value of clinical and transesophageal echocardiographic variables for risk stratification in patients with infective endocarditis. Clin Cardiol 1998, 21:572–578.
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Chu, V.H., Bayer, A.S. Use of echocardiography in the diagnosis and management of infective endocarditis. Curr Infect Dis Rep 9, 283–290 (2007). https://doi.org/10.1007/s11908-007-0044-x
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DOI: https://doi.org/10.1007/s11908-007-0044-x