经胸与经食管超声心动图对感染性心内膜炎的诊断价值比较

王辉; 倪超; 郭立琳; 朱文玲

doi:10.3969/j.issn.1674-9081.2012.03.014

经胸与经食管超声心动图对感染性心内膜炎的诊断价值比较

Comparison of Diagnostic Value of Tansthoracic and Transesophageal Echocardiography in Patients with Infective Endocarditis

摘要

摘要:
目的比较经胸超声心动图(transthoracic echocardiography, TTE)和经食管超声心动图(transesophageal echocardiography, TEE)诊断感染性心内膜炎(infective endocarditis, IE)的准确性。
方法回顾性分析2003年1月至2011年12月北京协和医院诊断的95例IE患者的临床及超声心动图特点, 比较TTE和TEE对赘生物和IE相关并发症的检出率, 并以TEE作为诊断IE的标准来评价TTE诊断的准确性。
结果 TEE对赘生物的阳性检出率显著高于TTE(81.1%比52.6%, P < 0.001);若以TEE阳性作为诊断IE的标准, 则TTE检出赘生物的敏感性为64.9%, 特异性为94.4%;TEE对IE瓣周并发症诊断的敏感性也显著高于TTE(P < 0.05)。
结论 TTE对赘生物检出的阳性率较低; TEE不仅在检出赘生物方面较TTE更敏感, 对IE瓣周并发症诊断的敏感性也更高。

Abstract:
Objective To compare the diagnostic accuracy of transthoracic echocardiography (TTE) versus transesophageal echocardiography (TEE) in patients with suspected infective endocarditis (IE).
Methods The clinical and echocardiographic characteristics of 95 patients with IE diagnosed from January 2003 to December 2011 in Peking Union Medical College Hospital were retrospectively analyzed. The detection rate of TTE and TEE for valvular vegetations and periannular complications of IE was compared, and the diagnostic accuracy of TTE was assessed using TEE as the reference standard for diagnosis of IE.
Results TEE was more sensitive than TTE in identifying valvular vegetations (81.1% vs. 52.6%, P < 0.001). Using positive TEE cardiac findings as the reference standard, the sensitivity and specificity for TTE was 64.9% and 94.4% for the detection of vegetation, respectively. Also, TEE was significantly more sensitive than TTE at defining periannular complications of IE (P < 0.05). Vegetation on TTE and positive blood cultures were correlated with vegetation on TEE.
Conclusion TTE has a limited capacity in detecting valvular vegetations. TEE is more sensitive than TTE in detecting valvular vegetations and identifying periannular complications in IE patients.

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