Diagnostic value of two-dimensional transoesophageal versus transthoracic echocardiography in patients with infective endocarditis

In 96 patients (64 men, 32 women; age range 17–84 years) with clinically suspected infective endocarditis, transthoracic (TTE) and transoesophageal echocardiography (TEE) were performed to evaluate the diagnostic relevance of the detection of vegetations. By TTE 29 vegetations could be demonstrated in 27 of the 96 patients (28%), whereas by TEE51 vegetations were found in 46 of the 96 patients (48%). Vegetative lesions smaller than 10 mm were detected in only about 41% by TTE. In 19 out of 20 patients who underwent surgery or autopsy, vegetations were confirmed. They had been detected in 12 out of 19 cases by TTE(63%), but in all of the 19 cases by TEE (100%). In one patient, TEE was falsely positive. Irrespective of the results of blood cultures (positive or negative) in patients with vegetations seen by TEE, the incidence of cardiac murmurs and embolism was higher than in patients without vegetations. TEE is superior to TTE in the detection of vegetative lesions in patients with suspected endocarditis, particularly when the vegetations are small. The demonstration of vegetations by TEE may play a role in the assessment of clinical outcome of the patients. In particular, TEE is indicated in patients with negative blood cultures and clinical suspicion of endocarditis.