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

  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.