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The Prospective Role of Transesophageal Echocardiography in the Diagnosis and Management of Patients with Suspected Infective Endocarditis
Author(s) -
Harris Kevin M.,
Li Dean Y.,
L'Ecuyer Paul,
Moon Karl E.T.,
German Matt,
Fraser Victoria,
Barzilai Benico
Publication year - 2003
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1046/j.1540-8175.2003.00007.x
Subject(s) - medicine , infective endocarditis , pre and post test probability , endocarditis , prospective cohort study , cardiology , radiology
Study Objectives: Transesophageal echocardiography (TEE) has a high sensitivity for the diagnosis of infective endocarditis (IE), but the prospective role of TEE when added to a careful clinical examination has not been well‐studied. Design: We compared the results of TEE to a clinical evaluation by an infectious disease specialist in 43 consecutive patients in whom TEE was ordered to rule out IE. Prior to TEE, the patients were classified on clinical grounds as to their likelihood of IE using a modification of the von Reyn criteria. Changes in management occurring as a result of TEE also were evaluated. Measurements and Results: TEE was positive in 11 patients, negative in 29, and indeterminate in 3. TEE was positive in 6 (46%) of 13 high probability patients, 2 (67%) of medium probability patients, and 3 (11%) of 27 low probability patients. A change in management based on TEE occurred in 4 (31%) patients with high probability, in no patients with medium probability, and in 1 (4%) patient with low probability. Conclusions: TEE confirms IE in patients with high probability of IE and often leads to a management change. However, TEE is unlikely to establish the diagnosis or change management in patients with low probability. (ECHOCARDIOGRAPHY, Volume 20, January 2003)