Shafiyi Aylin, Anavekar Nandan S, Virk Abinash, Sohail M Rizwan, Lahr Brian D, DeSimone Daniel C, Wilson Walter R, Baddour Larry M
Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
Echocardiography. 2020 Jun;37(6):891-899. doi: 10.1111/echo.14676. Epub 2020 May 16.
Current guidelines from the American Heart Association (AHA) recommend repeating transesophageal echocardiography (TEE) in three to five days if there is high suspicion of IE despite an initial TEE that was negative. This recommendation, however, is based on limited published data.
This investigation attempts to identify specific factors that prompted repeat TEE and evaluate the yield of IE-related findings demonstrated by repeat TEE as compared to initial or prior TEE.
A retrospective cohort who had at least one repeat TEE during an index hospitalization or initial course of antimicrobial therapy for IE between January 2014 and September 2018. We assessed the impact of repeat TEE on IE diagnosis and patient management and included a comparative analysis of patients with initial TEE only.
Overall, 59 (44.7%) of 132 IE patients underwent repeat TEE. In a comparative analysis that involved patients who had undergone an initial TEE only versus those who had repeat TEE, male gender (P = .029) and presence of a prosthetic valve or annuloplasty ring (P = .017) were significantly associated with repeat TEE. Importantly, 8 (17.4%) of repeat TEE were critical for IE diagnosis, 8 (17.4%) impacted antimicrobial management, and 11 (23.9%) supported cardiovascular surgical intervention.
From a population-based cohort of incident IE cases, repeat TEE was more frequently (44.7%) done in patients with suspect or proven IE and associated complications than anticipated. Repeat TEE remains pivotal in a contemporary practice that involves critical aspects of IE diagnosis and management.
美国心脏协会（AHA）目前的指南建议，如果尽管初次经食管超声心动图（TEE）结果为阴性，但仍高度怀疑感染性心内膜炎（IE），则应在三至五天后重复进行TEE检查。然而，这一建议基于有限的已发表数据。
本研究旨在确定促使重复进行TEE检查的具体因素，并评估与初次或之前的TEE相比，重复TEE所显示的IE相关发现的检出率。
对2014年1月至2018年9月期间因IE在首次住院或初始抗菌治疗过程中至少进行过一次重复TEE检查的回顾性队列进行研究。我们评估了重复TEE对IE诊断和患者管理的影响，并纳入了仅进行初次TEE检查患者的对比分析。
总体而言，132例IE患者中有59例（44.7%）接受了重复TEE检查。在一项对比分析中，仅进行过初次TEE检查的患者与接受重复TEE检查的患者相比，男性（P = 0.029）以及存在人工瓣膜或瓣环成形环（P = 0.017）与重复TEE检查显著相关。重要的是，8例（17.4%）重复TEE检查对IE诊断至关重要，8例（17.4%）影响抗菌治疗管理，11例（23.9%）支持心血管外科干预。
在基于人群的新发IE病例队列中，与预期相比，疑似或确诊IE及相关并发症患者更频繁地（44.7%）进行了重复TEE检查。在涉及IE诊断和管理关键方面的当代实践中，重复TEE检查仍然至关重要。
