Role of negative transthoracic echocardiography in excluding infective endocarditis
Abstract Background Recent guidelines suggest an extensive role of transesophageal echocardiography (TOE) in the diagnostic work-up for suspected infective endocarditis (IE). However, the negative predictive value of transthoracic echocardiography (TTE) remains poorly investigated. Purpose The purpo...
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| creator | Cambise, N Tremamunno, S Marino, A Lenci, L De Benedetto, F Belmusto, A Tinti, L Di Renzo, A Di Perna, F Buonamassa, G Pontecorvo, S Lombardo, A Lanza, G A |
| description | Abstract
Background
Recent guidelines suggest an extensive role of transesophageal echocardiography (TOE) in the diagnostic work-up for suspected infective endocarditis (IE).
However, the negative predictive value of transthoracic echocardiography (TTE) remains poorly investigated.
Purpose
The purpose of our study was to evaluate the accuracy of TTE in ruling out IE in order to avoid unnecessary TOE, a more invasive and expensive diagnostic exam.
Methods
We reviewed data of 637 consecutive patients referred to our laboratory of echocardiography with a suspected diagnosis of IE who underwent TOE within 14 days of TTE (median 4.4 days; interquartile range 2.4-7.4). For each patient we obtained age, sex, blood culture results, complete blood count, blood chemistry, evidence of systemic embolism or pulmonary embolism, and presence of moderate/severe heart valve disease, congenital heart disease, valve prostheses and intracardiac devices.
Patients with initial doubtful findings at TOE were referred for a follow-up TOE after one week and/or 18F fluorodeoxyglucose positron emission tomography computed tomography to achieve a definitive clinical diagnosis. Patients in whom a clear diagnosis of IE could not be achieved (n=7) were considered to have the disease.
Results
Of the 637 patients enrolled, 375 had negative TTE for IE (59%). TOE was positive and doubtful for IE in 44 (12%) and 29 (8%) of these patients, respectively.
After further assessment, a final diagnosis of IE was achieved in 56 patients (15%).
Variables associated with IE at univariable analysis included presence of valve prostheses (p |
| doi_str_mv | 10.1093/eurheartj/ehae666.1965 |
| format | Article |
| fullrecord | <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_eurheartj_ehae666_1965</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehae666.1965</oup_id><sourcerecordid>10.1093/eurheartj/ehae666.1965</sourcerecordid><originalsourceid>FETCH-LOGICAL-c895-ef29290e8e6f5365fc1441b0390f67229e2cb589e504aa56e6e5c3534fea8ce83</originalsourceid><addsrcrecordid>eNqNkM1KxDAUhYMoWEdfQfoCnUnS5posZfAPBgSdhbuSSW_aDLUpSSvO29uxg2tXlwP3Oxw-Qm4ZXTKq8hWOoUEdhv0KG40AsGQKxBlJmOA8U1CIc5JQpkQGID8uyVWMe0qpBAYJeX_zLabeph3WenBfmA5Bd3FofNDGmRRN440OlfN10H1zSF2X4rdpx8p19RQsml8Ku2r-G1y8JhdWtxFvTndBto8P2_Vztnl9elnfbzIjpzFoueKKokSwIgdhDSsKtqO5ohbuOFfIzU5IhYIWWgtAQGFykRcWtTQo8wWBudYEH2NAW_bBfepwKBktj2bKPzPlyUx5NDOBbAb92P-X-QESI25v</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Role of negative transthoracic echocardiography in excluding infective endocarditis</title><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Cambise, N ; Tremamunno, S ; Marino, A ; Lenci, L ; De Benedetto, F ; Belmusto, A ; Tinti, L ; Di Renzo, A ; Di Perna, F ; Buonamassa, G ; Pontecorvo, S ; Lombardo, A ; Lanza, G A</creator><creatorcontrib>Cambise, N ; Tremamunno, S ; Marino, A ; Lenci, L ; De Benedetto, F ; Belmusto, A ; Tinti, L ; Di Renzo, A ; Di Perna, F ; Buonamassa, G ; Pontecorvo, S ; Lombardo, A ; Lanza, G A</creatorcontrib><description>Abstract
Background
Recent guidelines suggest an extensive role of transesophageal echocardiography (TOE) in the diagnostic work-up for suspected infective endocarditis (IE).
However, the negative predictive value of transthoracic echocardiography (TTE) remains poorly investigated.
Purpose
The purpose of our study was to evaluate the accuracy of TTE in ruling out IE in order to avoid unnecessary TOE, a more invasive and expensive diagnostic exam.
Methods
We reviewed data of 637 consecutive patients referred to our laboratory of echocardiography with a suspected diagnosis of IE who underwent TOE within 14 days of TTE (median 4.4 days; interquartile range 2.4-7.4). For each patient we obtained age, sex, blood culture results, complete blood count, blood chemistry, evidence of systemic embolism or pulmonary embolism, and presence of moderate/severe heart valve disease, congenital heart disease, valve prostheses and intracardiac devices.
Patients with initial doubtful findings at TOE were referred for a follow-up TOE after one week and/or 18F fluorodeoxyglucose positron emission tomography computed tomography to achieve a definitive clinical diagnosis. Patients in whom a clear diagnosis of IE could not be achieved (n=7) were considered to have the disease.
Results
Of the 637 patients enrolled, 375 had negative TTE for IE (59%). TOE was positive and doubtful for IE in 44 (12%) and 29 (8%) of these patients, respectively.
After further assessment, a final diagnosis of IE was achieved in 56 patients (15%).
Variables associated with IE at univariable analysis included presence of valve prostheses (p<0.001), systemic or pulmonary embolism (p<0.001), lower platelet count (p=0.003), positive blood culture (p=0.005), aortic valve regurgitation (p=0.02), aortic valve stenosis (p=0.03) and mitral regurgitation (p=0.03).
At multivariable logistic regression, independent predictors of IE (OR=odds ratio; CI=confidence interval) included evidence of systemic or pulmonary embolism (OR 17.75, 95% CI 6.66-47.3, p<0.001), bioprosthetic heart valves (OR 2.93, 95% CI 1.31-6.53 p=0.023) and lower platelet count (OR 0.995, 95% CI 0.991-0.998, p=0.003).
Among the subgroup of patients (n=183, 49%) with no evidence of embolism, no bioprosthetic valve and platelet count >190,000/mL (median value), IE was diagnosed in 11 patients only (6%).
Conclusions
In our study, a negative TTE in the subgroup of patients with suspected IE showing platelet count >190,000/mL and absence of embolism and valvular bio-prosthesis, had a negative predictive value for IE of 94%, suggesting that, in this subset of patients, TOE can initially be delayed and performed only if clinical suspicion continues to remain high.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehae666.1965</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2024-10, Vol.45 (Supplement_1)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids></links><search><creatorcontrib>Cambise, N</creatorcontrib><creatorcontrib>Tremamunno, S</creatorcontrib><creatorcontrib>Marino, A</creatorcontrib><creatorcontrib>Lenci, L</creatorcontrib><creatorcontrib>De Benedetto, F</creatorcontrib><creatorcontrib>Belmusto, A</creatorcontrib><creatorcontrib>Tinti, L</creatorcontrib><creatorcontrib>Di Renzo, A</creatorcontrib><creatorcontrib>Di Perna, F</creatorcontrib><creatorcontrib>Buonamassa, G</creatorcontrib><creatorcontrib>Pontecorvo, S</creatorcontrib><creatorcontrib>Lombardo, A</creatorcontrib><creatorcontrib>Lanza, G A</creatorcontrib><title>Role of negative transthoracic echocardiography in excluding infective endocarditis</title><title>European heart journal</title><description>Abstract
Background
Recent guidelines suggest an extensive role of transesophageal echocardiography (TOE) in the diagnostic work-up for suspected infective endocarditis (IE).
However, the negative predictive value of transthoracic echocardiography (TTE) remains poorly investigated.
Purpose
The purpose of our study was to evaluate the accuracy of TTE in ruling out IE in order to avoid unnecessary TOE, a more invasive and expensive diagnostic exam.
Methods
We reviewed data of 637 consecutive patients referred to our laboratory of echocardiography with a suspected diagnosis of IE who underwent TOE within 14 days of TTE (median 4.4 days; interquartile range 2.4-7.4). For each patient we obtained age, sex, blood culture results, complete blood count, blood chemistry, evidence of systemic embolism or pulmonary embolism, and presence of moderate/severe heart valve disease, congenital heart disease, valve prostheses and intracardiac devices.
Patients with initial doubtful findings at TOE were referred for a follow-up TOE after one week and/or 18F fluorodeoxyglucose positron emission tomography computed tomography to achieve a definitive clinical diagnosis. Patients in whom a clear diagnosis of IE could not be achieved (n=7) were considered to have the disease.
Results
Of the 637 patients enrolled, 375 had negative TTE for IE (59%). TOE was positive and doubtful for IE in 44 (12%) and 29 (8%) of these patients, respectively.
After further assessment, a final diagnosis of IE was achieved in 56 patients (15%).
Variables associated with IE at univariable analysis included presence of valve prostheses (p<0.001), systemic or pulmonary embolism (p<0.001), lower platelet count (p=0.003), positive blood culture (p=0.005), aortic valve regurgitation (p=0.02), aortic valve stenosis (p=0.03) and mitral regurgitation (p=0.03).
At multivariable logistic regression, independent predictors of IE (OR=odds ratio; CI=confidence interval) included evidence of systemic or pulmonary embolism (OR 17.75, 95% CI 6.66-47.3, p<0.001), bioprosthetic heart valves (OR 2.93, 95% CI 1.31-6.53 p=0.023) and lower platelet count (OR 0.995, 95% CI 0.991-0.998, p=0.003).
Among the subgroup of patients (n=183, 49%) with no evidence of embolism, no bioprosthetic valve and platelet count >190,000/mL (median value), IE was diagnosed in 11 patients only (6%).
Conclusions
In our study, a negative TTE in the subgroup of patients with suspected IE showing platelet count >190,000/mL and absence of embolism and valvular bio-prosthesis, had a negative predictive value for IE of 94%, suggesting that, in this subset of patients, TOE can initially be delayed and performed only if clinical suspicion continues to remain high.</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNkM1KxDAUhYMoWEdfQfoCnUnS5posZfAPBgSdhbuSSW_aDLUpSSvO29uxg2tXlwP3Oxw-Qm4ZXTKq8hWOoUEdhv0KG40AsGQKxBlJmOA8U1CIc5JQpkQGID8uyVWMe0qpBAYJeX_zLabeph3WenBfmA5Bd3FofNDGmRRN440OlfN10H1zSF2X4rdpx8p19RQsml8Ku2r-G1y8JhdWtxFvTndBto8P2_Vztnl9elnfbzIjpzFoueKKokSwIgdhDSsKtqO5ohbuOFfIzU5IhYIWWgtAQGFykRcWtTQo8wWBudYEH2NAW_bBfepwKBktj2bKPzPlyUx5NDOBbAb92P-X-QESI25v</recordid><startdate>20241028</startdate><enddate>20241028</enddate><creator>Cambise, N</creator><creator>Tremamunno, S</creator><creator>Marino, A</creator><creator>Lenci, L</creator><creator>De Benedetto, F</creator><creator>Belmusto, A</creator><creator>Tinti, L</creator><creator>Di Renzo, A</creator><creator>Di Perna, F</creator><creator>Buonamassa, G</creator><creator>Pontecorvo, S</creator><creator>Lombardo, A</creator><creator>Lanza, G A</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20241028</creationdate><title>Role of negative transthoracic echocardiography in excluding infective endocarditis</title><author>Cambise, N ; Tremamunno, S ; Marino, A ; Lenci, L ; De Benedetto, F ; Belmusto, A ; Tinti, L ; Di Renzo, A ; Di Perna, F ; Buonamassa, G ; Pontecorvo, S ; Lombardo, A ; Lanza, G A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c895-ef29290e8e6f5365fc1441b0390f67229e2cb589e504aa56e6e5c3534fea8ce83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cambise, N</creatorcontrib><creatorcontrib>Tremamunno, S</creatorcontrib><creatorcontrib>Marino, A</creatorcontrib><creatorcontrib>Lenci, L</creatorcontrib><creatorcontrib>De Benedetto, F</creatorcontrib><creatorcontrib>Belmusto, A</creatorcontrib><creatorcontrib>Tinti, L</creatorcontrib><creatorcontrib>Di Renzo, A</creatorcontrib><creatorcontrib>Di Perna, F</creatorcontrib><creatorcontrib>Buonamassa, G</creatorcontrib><creatorcontrib>Pontecorvo, S</creatorcontrib><creatorcontrib>Lombardo, A</creatorcontrib><creatorcontrib>Lanza, G A</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cambise, N</au><au>Tremamunno, S</au><au>Marino, A</au><au>Lenci, L</au><au>De Benedetto, F</au><au>Belmusto, A</au><au>Tinti, L</au><au>Di Renzo, A</au><au>Di Perna, F</au><au>Buonamassa, G</au><au>Pontecorvo, S</au><au>Lombardo, A</au><au>Lanza, G A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of negative transthoracic echocardiography in excluding infective endocarditis</atitle><jtitle>European heart journal</jtitle><date>2024-10-28</date><risdate>2024</risdate><volume>45</volume><issue>Supplement_1</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Background
Recent guidelines suggest an extensive role of transesophageal echocardiography (TOE) in the diagnostic work-up for suspected infective endocarditis (IE).
However, the negative predictive value of transthoracic echocardiography (TTE) remains poorly investigated.
Purpose
The purpose of our study was to evaluate the accuracy of TTE in ruling out IE in order to avoid unnecessary TOE, a more invasive and expensive diagnostic exam.
Methods
We reviewed data of 637 consecutive patients referred to our laboratory of echocardiography with a suspected diagnosis of IE who underwent TOE within 14 days of TTE (median 4.4 days; interquartile range 2.4-7.4). For each patient we obtained age, sex, blood culture results, complete blood count, blood chemistry, evidence of systemic embolism or pulmonary embolism, and presence of moderate/severe heart valve disease, congenital heart disease, valve prostheses and intracardiac devices.
Patients with initial doubtful findings at TOE were referred for a follow-up TOE after one week and/or 18F fluorodeoxyglucose positron emission tomography computed tomography to achieve a definitive clinical diagnosis. Patients in whom a clear diagnosis of IE could not be achieved (n=7) were considered to have the disease.
Results
Of the 637 patients enrolled, 375 had negative TTE for IE (59%). TOE was positive and doubtful for IE in 44 (12%) and 29 (8%) of these patients, respectively.
After further assessment, a final diagnosis of IE was achieved in 56 patients (15%).
Variables associated with IE at univariable analysis included presence of valve prostheses (p<0.001), systemic or pulmonary embolism (p<0.001), lower platelet count (p=0.003), positive blood culture (p=0.005), aortic valve regurgitation (p=0.02), aortic valve stenosis (p=0.03) and mitral regurgitation (p=0.03).
At multivariable logistic regression, independent predictors of IE (OR=odds ratio; CI=confidence interval) included evidence of systemic or pulmonary embolism (OR 17.75, 95% CI 6.66-47.3, p<0.001), bioprosthetic heart valves (OR 2.93, 95% CI 1.31-6.53 p=0.023) and lower platelet count (OR 0.995, 95% CI 0.991-0.998, p=0.003).
Among the subgroup of patients (n=183, 49%) with no evidence of embolism, no bioprosthetic valve and platelet count >190,000/mL (median value), IE was diagnosed in 11 patients only (6%).
Conclusions
In our study, a negative TTE in the subgroup of patients with suspected IE showing platelet count >190,000/mL and absence of embolism and valvular bio-prosthesis, had a negative predictive value for IE of 94%, suggesting that, in this subset of patients, TOE can initially be delayed and performed only if clinical suspicion continues to remain high.</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehae666.1965</doi></addata></record> |
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| ispartof | European heart journal, 2024-10, Vol.45 (Supplement_1) |
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| source | Oxford University Press Journals All Titles (1996-Current) |
| title | Role of negative transthoracic echocardiography in excluding infective endocarditis |
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