Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.
Heart Lung. 2011 Jul-Aug;40(4):358-60. doi: 10.1016/j.hrtlng.2010.07.007. Epub 2011 Apr 11.
We recently reviewed our experience with paired transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) studies for the diagnosis of native valve infective endocarditis. In patients with normal heart valves, we demonstrated that a normal TTE effectively rules out infective endocarditis and a TTE is unnecessary. In patients with abnormal heart valves, a TEE did not enhance the diagnostic yield in most patients (12/15). We reviewed 87 paired TTEs and TEEs, that is, TEE with a preceding TTE performed for the evaluation of native valve IE. Of 87 paired echocardiograms, 72 of 87 had normal TTEs and TEEs, with no evidence of a vegetation indicative of infective endocarditis. A total of 15 of 87 TTEs had thickened/calcified valves without a definite vegetation. Of these, only 3 of 15 were subsequently shown to have a vegetation indicative of endocarditis by TEE. In patients with possible native valve infective endocarditis, before blood culture results are known, a negative TTE was sufficiently specific to rule out native valve infective endocarditis. Our data showed that the negative predictive value of a normal TTE in the evaluation of possible native valve endocarditis is 90% or greater. In those with some valve abnormality (ie, thickened/calcified heart valves), subsequent TTE did not materially increase vegetation detection.
我们最近回顾了经胸超声心动图（TTE）和经食管超声心动图（TEE）在诊断原生瓣膜感染性心内膜炎中的应用经验。在正常心脏瓣膜的患者中，我们证明正常的 TTE 可有效排除感染性心内膜炎，且 TTE 并非必需。在心脏瓣膜异常的患者中，TEE 并未提高大多数患者（12/15）的诊断率。我们回顾了 87 例 TTE 和 TEE 配对检查，即 TEE 是在 TTE 评估原生瓣膜 IE 之前进行的。在 87 对超声心动图中，72 例 TTE 和 TEE 正常，无感染性心内膜炎提示性的赘生物。15 例 TTE 中有增厚/钙化的瓣膜，但没有明确的赘生物。其中，只有 3 例 TEE 随后显示有赘生物提示心内膜炎。在疑似原生瓣膜感染性心内膜炎的患者中，在获得血培养结果之前，阴性 TTE 具有足够的特异性来排除原生瓣膜感染性心内膜炎。我们的数据表明，正常 TTE 在评估疑似原生瓣膜心内膜炎中的阴性预测值大于或等于 90%。在那些存在某些瓣膜异常（即，增厚/钙化的心脏瓣膜）的患者中，随后的 TTE 并没有明显提高赘生物的检出率。
