经胸和经食管超声心动图用于疑似感染性心内膜炎的指征：赘生物、血培养和影像学检查。

Transthoracic and transesophageal echocardiography for the indication of suspected infective endocarditis: vegetations, blood cultures and imaging.

机构信息

Hospital of the University of Pennsylvania, Department of Medicine, Cardiovascular Division, Philadelphia, Pennsylvania, USA.

出版信息

J Am Soc Echocardiogr. 2010 Apr;23(4):396-402. doi: 10.1016/j.echo.2009.12.017.

DOI:10.1016/j.echo.2009.12.017

PMID:20138467

Abstract

BACKGROUND

The aim of this study was to investigate the ability of transthoracic echocardiography (TTE) to detect vegetations and the relationship between blood cultures and transesophageal echocardiography (TEE).

METHODS

Five hundred eleven TTE and TEE pairs performed to evaluate endocarditis were retrospectively analyzed. Vegetation on TTE, prosthetic valve, change in regurgitation, and blood cultures were correlated with vegetation on TEE.

RESULTS

TTE detected 45% of vegetations seen on TEE. There was no difference for prosthetic valves. Prosthetic valves (odds ratio, 1.7; P = .03) and increased regurgitation (odds ratio, 1.7; P = .01) were associated with vegetations on TEE; staphylococcal bacteremia and fungemia were not. Negative blood cultures were associated with negative results on TEE (P < .0001), but 27% of patients with prosthetic valves had culture-negative endocarditis or nonbacterial thrombotic endocarditis, and 6% had abscesses missed by TTE.

CONCLUSION

This study demonstrates a limited capacity of TTE to detect vegetations. TEE may be an appropriate initial study to evaluate prosthetic valves. TEE for culture-negative endocarditis deserves further study.

摘要

背景

本研究旨在探讨经胸超声心动图（TTE）检测赘生物的能力以及血培养与经食管超声心动图（TEE）之间的关系。

方法

回顾性分析了 511 对用于评估心内膜炎的 TTE 和 TEE 检查。将 TTE 上的赘生物、人工瓣膜、反流变化与 TEE 上的赘生物进行相关性分析。

结果

TTE 检测到 45% TEE 上可见的赘生物。对于人工瓣膜没有差异。人工瓣膜（比值比，1.7；P =.03）和反流增加（比值比，1.7；P =.01）与 TEE 上的赘生物有关；葡萄球菌菌血症和真菌血症则没有。血培养阴性与 TEE 阴性结果相关（P <.0001），但 27%的人工瓣膜患者存在血培养阴性的心内膜炎或非细菌性血栓性心内膜炎，且 6%的患者 TTE 漏诊了脓肿。