Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Prendergast BD. The changing face of infective endocarditis. Heart. 2006;92:879–85. doi:10.1136/hrt.2005.067256.

    Article  CAS  PubMed  Google Scholar 

  2. Heiro M, Helenius H, Hurme S, et al. Long-term outcome of infective endocarditis: a study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years. BMC Infect Dis. 2008;8:49. doi:10.1186/1471-2334-8-49.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Moreillon P, Que Y-A. Infective endocarditis. Lancet. 2004;363:139–49. doi:10.1016/S0140-6736(03)15266-X.

    Article  PubMed  Google Scholar 

  4. Khanna N, Roy A, Bahl VK. Janeway lesions: an old sign revisited. Circulation. 2013;127:861. doi:10.1161/CIRCULATIONAHA.112.127787.

    Article  PubMed  Google Scholar 

  5. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8. doi:10.1086/313753.

    Article  CAS  PubMed  Google Scholar 

  6. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the task force on the prevention, diagnosis, and treatment of infective endocarditis of the European society of cardiology (ESC). Endorsed by the European. Eur Heart J. 2009;30:2369–413. doi:10.1093/eurheartj/ehp285.

    Article  PubMed  Google Scholar 

  7. Habib G, Badano L, Tribouilloy C, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11:202–19. doi:10.1093/ejechocard/jeq004.

    Article  PubMed  Google Scholar 

  8. Liu Y, Tsai W, Lin C. Usefulness of real-time three-dimensional echocardiography for diagnosis of infective endocarditis. Scand Cardiovasc J. 2009;43:318–23. doi:10.1080/14017430902737940.

    Article  PubMed  Google Scholar 

  9. Hansalia S, Biswas M, Dutta R, et al. The value of live/real time three-dimensional transesophageal echocardiography in the assessment of valvular vegetations. Echocardiography. 2009;26:1264–73. doi:10.1111/j.1540-8175.2009.01042.x.

    Article  PubMed  Google Scholar 

  10. Berdejo J, Shibayama K, Harada K, et al. Evaluation of vegetation size and its relationship with embolism in infective endocarditis: a real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging. 2014;7:149–54. doi:10.1161/CIRCIMAGING.113.000938.

    Article  PubMed  Google Scholar 

  11. Kort S. Real-time 3-dimensional echocardiography for prosthetic valve endocarditis: initial experience. J Am Soc Echocardiogr. 2006;19:130–9. doi:10.1016/j.echo.2005.08.023.

    Article  PubMed  Google Scholar 

  12. Tanis W, Teske AJ, van Herwerden LA, et al. The additional value of three-dimensional transesophageal echocardiography in complex aortic prosthetic heart valve endocarditis. Echocardiography. 2014;. doi:10.1111/echo.12602.

    PubMed  Google Scholar 

  13. Kenzaka T, Nishimura Y. Three-dimensional transoesophageal echocardiography for the diagnosis of prosthetic valve endocarditis. BMJ Case Rep. 2014;2014:1–2. doi:10.1136/bcr-2014-203592.

    Google Scholar 

  14. Caselli S, Mazzesi G, Tritapepe L, et al. 3D echocardiographic delineation of mitral-aortic intervalular fibrosa pseudoaneurysm caused by bicuspid aortic valve endocarditis. Echocardiography. 2011;28:E1–4. doi:10.1111/j.1540-8175.2010.01229.x.

    Article  PubMed  Google Scholar 

  15. Penugonda N, Duncan K, Afonso L. Complex endocarditis in an immunocompromised host: the role of three-dimensional echocardiography. J Am Soc Echocardiogr. 2007;20:1314.e9–11. doi:10.1016/j.echo.2007.02.033.

    Article  PubMed  Google Scholar 

  16. Walker N, Bhan A, Desai J, Monaghan MJ. Myocardial abscess: a rare complication of valvular endocarditis demonstrated by 3D contrast echocardiography. Eur J Echocardiogr. 2010;11:E37. doi:10.1093/ejechocard/jeq090.

    Article  PubMed  Google Scholar 

  17. Pothineni KR, Inamdar V, Miller AP, et al. Initial experience with live/real time three-dimensional transesophageal echocardiography. Echocardiography. 2007;24:1099–104. doi:10.1111/j.1540-8175.2007.00598.x.

    Article  PubMed  Google Scholar 

  18. Pepi M, Tamborini G, Maltagliati A, et al. Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol. 2006;48:2524–30. doi:10.1016/j.jacc.2006.02.079.

    Article  PubMed  Google Scholar 

  19. García-Orta R, Moreno E, Vidal M, et al. Three-dimensional versus two-dimensional transesophageal echocardiography in mitral valve repair. J Am Soc Echocardiogr. 2007;20:4–12. doi:10.1016/j.echo.2006.07.005.

    Article  PubMed  Google Scholar 

  20. Grewal J, Mankad S, Freeman WK, et al. Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease. J Am Soc Echocardiogr. 2009;22:34–41. doi:10.1016/j.echo.2008.11.008.

    Article  PubMed  Google Scholar 

  21. Buck T, Breithardt OA, Fabe L, et al. Manual zur Indikation und Durchführung der Echokardiographie. Clin Res Cardiol Suppl. 2009;4:3–51. doi:10.1007/s11789-009-0051-6.

    Article  Google Scholar 

  22. Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis-prospective cohort study. Arch Intern Med. 2009;169:463–73. doi:10.1001/archinternmed.2008.603.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Habib G. Management of infective endocarditis. Heart. 2006;92:124–30. doi:10.1136/hrt.2005.063719.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lang RM, Tsang W, Weinert L, et al. Valvular heart disease: the value of 3-dimensional echocardiography. J Am Coll Cardiol. 2011;58:1933–44. doi:10.1016/j.jacc.2011.07.035.

    Article  PubMed  Google Scholar 

  25. Anwar AM, Nosir YFM, Alasnag M, Chamsi-Pasha H. Real time three-dimensional transesophageal echocardiography: a novel approach for the assessment of prosthetic heart valves. Echocardiography. 2014;31:188–96. doi:10.1111/echo.12327.

    Article  PubMed  Google Scholar 

  26. Singh P, Manda J, Hsiung MC, et al. Live/real time three-dimensional transesophageal echocardiographic evaluation of mitral and aortic valve prosthetic paravalvular regurgitation. Echocardiography. 2009;26:980–7. doi:10.1111/j.1540-8175.2009.01022.x.

    Article  PubMed  Google Scholar 

  27. Lang RM, Badano LP, Tsang W, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13:1–46. doi:10.1093/ehjci/jer316.

    Article  PubMed  Google Scholar 

  28. Flachskampf FA, Wouters PF, Edvardsen T, et al. Recommendations for transoesophageal echocardiography: EACVI update 2014. Eur Heart J Cardiovasc Imaging. 2014;15:353–65. doi:10.1093/ehjci/jeu015.

    Article  PubMed  Google Scholar 

  29. Sungur A, Hsiung MC, Meggo Quiroz LD, et al. The advantages of live/real time three-dimensional transesophageal echocardiography in the assessment of tricuspid valve infective endocarditis. Echocardiography. 2014;31:1293–309. doi:10.1111/echo.12785.

    Article  PubMed  Google Scholar 

  30. Ducas R, Tsang W, Chong AA, et al. Echocardiography and vascular ultrasound: new developments and future directions. Can J Cardiol. 2013;29:304–16. doi:10.1016/j.cjca.2012.11.001.

    Article  PubMed  Google Scholar 

  31. Feuchtner GM, Stolzmann P, Dichtl W, et al. Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol. 2009;53:436–44. doi:10.1016/j.jacc.2008.01.077.

    Article  PubMed  Google Scholar 

  32. Pérez-Vázquez A, Fariñas MC, García-Palomo JD, et al. Evaluation of the Duke criteria in 93 episodes of prosthetic valve endocarditis: could sensitivity be improved? Arch Intern Med. 2000;160:1185–91.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department III of Internal Medicine, Heart Centre of the University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

      Roman Pfister, Yann Betton, Henrik ten Freyhaus, Stephan Baldus & Guido Michels

    2. Department I of Internal Medicine, University of Cologne, Cologne, Germany

      Norma Jung

    Authors
    1. Roman Pfister
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Yann Betton
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Henrik ten Freyhaus
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Norma Jung
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Stephan Baldus
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Guido Michels
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Roman Pfister.

    Ethics declarations

    Funding

    None.

    Conflict of interest

    The authors have no relevant conflicts of interest to disclose.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Roman Pfister and Yann Betton contributed equally.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Pfister, R., Betton, Y., Freyhaus, H.t. et al. Three-dimensional compared to two-dimensional transesophageal echocardiography for diagnosis of infective endocarditis. Infection 44, 725–731 (2016). https://doi.org/10.1007/s15010-016-0908-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s15010-016-0908-9

    Keywords

    Search

    Navigation