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

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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.

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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

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    1. Roman Pfister
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    Correspondence to Roman Pfister.

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    The authors have no relevant conflicts of interest to disclose.

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    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.

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

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    Roman Pfister and Yann Betton contributed equally.

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    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

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

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