Diagnostic performance of contemporary transesophageal echocardiography with modern imaging for infective endocarditis

Bryce Montané; Johnny Chahine; Andrew Fiore; Jafar Alzubi; Hanan Alnajjar; Jasmine Mutti; Richard A Grimm; Brian P Griffin; Bo Xu

doi:10.21037/cdt-22-431

Diagnostic performance of contemporary transesophageal echocardiography with modern imaging for infective endocarditis

Cardiovasc Diagn Ther. 2023 Feb 28;13(1):25-37. doi: 10.21037/cdt-22-431. Epub 2023 Feb 1.

Authors

Affiliations

¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
² Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.

^# Contributed equally.

Abstract

Background: Infective endocarditis (IE) is associated with high morbidity and mortality. Following an initial negative transesophageal echocardiogram (TEE), high clinical suspicion warrants repeat examination. We evaluated the diagnostic performance of contemporary TEE imaging for IE.

Methods: This retrospective cohort study included patients ≥18 years old undergoing ≥2 TEEs within 6 months, with confirmed diagnosis of IE based on Duke criteria, 70 in 2011 and 172 in 2019, were included. We compared the diagnostic performance of TEE for IE in 2019 versus 2011. The primary endpoint was the sensitivity of initial TEE to detect IE.

Results: Sensitivity of the initial TEE to detect endocarditis was 85.7% versus 95.3%, in 2011 and 2019, respectively (P=0.01). On multivariable analysis, initial TEE more frequently detected IE in 2019, compared to 2011 [odds ratio (OR): 4.06, 95% confidence intervals (CIs): 1.41-11.71, P=0.01]. Improved diagnostic performance was driven by improved detection of prosthetic valve infective endocarditis (PVIE), sensitivity 70.8% in 2011 versus 93.7% (P=0.009) in 2019. In 2019, TEEs more frequently utilized probes with higher frame rates/resolution, than 2011 (P<0.001). Three dimensional (3D) technology was utilized in 97.2% of initial TEEs in 2019, compared to 70.5% in 2011 (P<0.001).

Conclusions: Contemporary TEE was associated with improved diagnostic performance for endocarditis, driven by improved sensitivity for PVIE.

Keywords: Echocardiography; infective endocarditis (IE); three dimensional echocardiography; transesophageal echocardiography (TEE); valvular heart disease.