López Palmero Serafín, López Zúñiga Miguel Angel, Rodríguez Martínez Virginia, Reyes Parrilla Raul, Alguacil Muñoz Ana Maria, Sánchez-Yebra Romera Waldo, Martín Rico Patricia, Poquet Catalá Inmaculada, Jiménez Guardiola Carlos, Del Pozo Pérez Alfonso, Lobato Cano Ruben, Lazo Torres Ana Maria, López Martínez Gines, Díez García Luis Felipe, Parrón Carreño Tesifon
Internal Medicine Department, Torrecárdenas University Hospital, 04009 Almería, Spain.
Infectious Diseases Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain.
J Clin Med. 2022 Jun 23;11(13):3636. doi: 10.3390/jcm11133636.
In general, transthoracic echocardiography (TTE) is the first diagnostic test used for patients with bacteremia or candidemia and clinical signs of Infective Endocarditis (IE). Point-of-care ultrasound (POCUS) may be used in addition to physical examination for the detection of structural heart disease and valve abnormalities.
To determine the diagnostic accuracy of POCUS for the detection of signs suggestive of IE, including vegetation, valvular regurgitation, structural heart disease, hepatomegaly, splenomegaly and septic embolisms, in patients with bacteremia or candidemia.
Observational, cross-sectional, multicenter study using convenience sampling.
Six Spanish academic hospitals.
Adult patients with bacteremia or candidemia between 1 February 2018 and 31 December 2020.
The reference test, to evaluate vegetation, valvular regurgitation and structural heart disease, was transesophageal echocardiography (TEE). For patients who did not undergo TEE, transthoracic echocardiography (TTE) was considered the reference test. POCUS was performed by internists, while conventional echocardiography procedures were performed by cardiologists.
In 258 patients, for the detection of valvular vegetation, POCUS had sensitivity, specificity, and positive and negative predictive values of 77%, 94%, 82% and 92%, respectively. For valvular regurgitation (more than mild), sensitivity was ≥76% and specificity ≥85%. Sensitivity values for the detection of hepatomegaly and splenomegaly were 92% and 92%, respectively, while those for specificity were 96% and 98%.
POCUS could be a valuable tool, as a complement to physical examination, at the hospital bedside for patients with bacteremia or candidemia, helping to identify signs suggestive of IE.
一般而言，经胸超声心动图（TTE）是用于患有菌血症或念珠菌血症且有感染性心内膜炎（IE）临床体征患者的首要诊断检查。即时超声检查（POCUS）除体格检查外，可用于检测结构性心脏病和瓣膜异常。
确定POCUS对检测菌血症或念珠菌血症患者中提示IE的体征（包括赘生物、瓣膜反流、结构性心脏病、肝肿大、脾肿大和脓毒性栓塞）的诊断准确性。
采用便利抽样的观察性横断面多中心研究。
六家西班牙学术医院。
2018年2月1日至2020年12月31日期间患有菌血症或念珠菌血症的成年患者。
评估赘生物、瓣膜反流和结构性心脏病的参考检查为经食管超声心动图（TEE）。对于未接受TEE的患者，经胸超声心动图（TTE）被视为参考检查。POCUS由内科医生进行，而传统超声心动图检查由心脏病专家进行。
在258例患者中，对于瓣膜赘生物的检测，POCUS的敏感性、特异性、阳性预测值和阴性预测值分别为77%、94%、82%和92%。对于瓣膜反流（超过轻度），敏感性≥76%，特异性≥85%。肝肿大和脾肿大检测的敏感性值分别为92%和92%，而特异性值分别为96%和98%。
POCUS作为体格检查的补充，对于菌血症或念珠菌血症患者在医院床边可能是一种有价值的工具，有助于识别提示IE的体征。
