Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis: comparison with transesophageal echocardiography

2007

Diagnostic Value of Harmonic Transthoracic Echocardiography in Infective Endocarditis

Sample size: 36 publication Evidence: moderate

Author Information

Author(s): Jassal Davinder S, Aminbakhsh Amin, Fang Tielan, Shaikh Nasir, Embil John M, Mackenzie Gordon S, Tam James W

Primary Institution: Bergen Cardiac Care Centre, Cardiology Division, Department of Cardiac Sciences, St. Boniface General Hospital, Winnipeg, Manitoba, Canada

Hypothesis

To determine the diagnostic accuracy of detecting vegetations using harmonic transthoracic echocardiography (hTTE) as compared to transesophageal echocardiography (TEE) in patients with an intermediate likelihood of native valve infective endocarditis.

Conclusion

Harmonic transthoracic echocardiography provides high-quality diagnostic images for detecting vegetations in patients with an intermediate likelihood of infective endocarditis and should be the first line test.

Supporting Evidence

The sensitivity for the detection of vegetations by hTTE was 84%.
The specificity of hTTE was 88%.
The positive predictive value (PPV) of hTTE was 89%.
The negative predictive value (NPV) of hTTE was 82%.
91% of patients fulfilled the Duke criteria for typical blood cultures.
Only 17% of patients with an intermediate likelihood of IE remained nondiagnostic after hTTE imaging.

Takeaway

This study shows that a special type of heart ultrasound called harmonic transthoracic echocardiography is really good at finding problems in the heart valves of patients who might have an infection.