Harris Kevin M, Li Dean Y, L'Ecuyer Paul, Moon Karl E T, German Matt, Fraser Victoria, Barzilai Benico
Minneapolis Heart Institute, Minneapolis, Minnesota 55407, USA.
Echocardiography. 2003 Jan;20(1):57-62. doi: 10.1046/j.1540-8175.2003.00007.x.
Transesophageal echocardiography (TEE) has a high sensitivity for the diagnosis of infective endocarditis (IE), but the prospective role of TEE when added to a careful clinical examination has not been well-studied.
We compared the results of TEE to a clinical evaluation by an infectious disease specialist in 43 consecutive patients in whom TEE was ordered to rule out IE. Prior to TEE, the patients were classified on clinical grounds as to their likelihood of IE using a modification of the von Reyn criteria. Changes in management occurring as a result of TEE also were evaluated.
TEE was positive in 11 patients, negative in 29, and indeterminate in 3. TEE was positive in 6 (46%) of 13 high probability patients, 2 (67%) of medium probability patients, and 3 (11%) of 27 low probability patients. A change in management based on TEE occurred in 4 (31%) patients with high probability, in no patients with medium probability, and in 1 (4%) patient with low probability.
TEE confirms IE in patients with high probability of IE and often leads to a management change. However, TEE is unlikely to establish the diagnosis or change management in patients with low probability.
经食管超声心动图（TEE）对感染性心内膜炎（IE）的诊断具有较高的敏感性，但在仔细的临床检查基础上增加TEE的前瞻性作用尚未得到充分研究。
我们将43例因排除IE而接受TEE检查的连续患者的TEE结果与传染病专家的临床评估结果进行了比较。在进行TEE之前，根据von Reyn标准的修改版本，基于临床情况将患者分为IE可能性高低不同的类别。还评估了因TEE导致的管理变化。
TEE检查结果为阳性的患者有11例，阴性的有29例，不确定的有3例。在13例高可能性患者中，TEE阳性的有6例（46%）；在中等可能性患者中，阳性的有2例（67%）；在27例低可能性患者中，阳性的有3例（11%）。基于TEE结果，4例（31%）高可能性患者的管理发生了变化，中等可能性患者中无变化，1例（4%）低可能性患者的管理发生了变化。
TEE可确诊高可能性IE患者的IE，且常导致管理变化。然而，TEE不太可能确诊低可能性患者的IE或改变其管理方式。
