Ho Karen, Sanjoy Shubrandu, Kassir Sandy, Srivatsav Varun, Yeung Colin
Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada.
CJC Open. 2024 Apr 30;6(8):1013-1020. doi: 10.1016/j.cjco.2024.04.008. eCollection 2024 Aug.
Echocardiography plays a key role in the diagnosis of infective endocarditis (IE), and recommendations have been published regarding the appropriate use of transesophageal echocardiography (TEE). The objective of this study is to evaluate the utilization of TEE in Regina, Saskatchewan, in the diagnosis of IE.
A retrospective chart review was performed on patients aged ≥ 18 years who received a TEE test for the diagnosis of IE from January 1 to December 31, 2019. The primary outcome included the proportion of TEE uses that complied with the American College of Cardiology Foundation and American Society of Echocardiography (ACCF and ASE) recommendations and the European Society of Cardiology (ESC) recommendations.
A total of 204 admissions involving 188 patients who had TEE performed for the diagnosis of IE occurred within the study period. The mean age was 53.1 ± 17.1 years. Of the 204 TEE uses, 152 (74.5%) were considered appropriate by the ACCF and ASE recommendations. Having at least one predisposing condition (adjusted odds ratio [aOR] 4.30 [95% confidence interval [CI] 2.11-9.04), < 0.001]) was more likely to be associated with appropriate TEE use, per the ACCF and ASE criteria. Of the 204 TEE uses, only 80 (39.2%) were considered appropriate by the ESC recommendations. Having a history of intravenous drug use (aOR 3.08 [95% CI 1.08-9.27], = 0.04) and having blood cultures positive for IE-related organisms (aOR 2.31 [95% CI 1.16-4.80], = 0.02)) were more likely to be associated with appropriate TEE use, per ESC recommendations.
The current study suggests that the use of TEE in the diagnosis of IE demonstrated variable levels of adherence to recommendations published by the ACCF and ASE and by the ESC, with significant discrepancy between the two.
超声心动图在感染性心内膜炎（IE）的诊断中起着关键作用，关于经食管超声心动图（TEE）的合理应用已有相关推荐发表。本研究的目的是评估加拿大萨斯喀彻温省里贾纳市TEE在IE诊断中的应用情况。
对2019年1月1日至12月31日期间接受TEE检查以诊断IE的年龄≥18岁患者进行回顾性病历审查。主要结局包括TEE使用符合美国心脏病学基金会和美国超声心动图学会（ACCF和ASE）推荐以及欧洲心脏病学会（ESC）推荐的比例。
在研究期间，共有204例涉及188例接受TEE检查以诊断IE的入院病例。平均年龄为53.1±17.1岁。在204次TEE使用中，根据ACCF和ASE推荐，152次（74.5%）被认为是合适的。根据ACCF和ASE标准，至少有一种易感因素（调整优势比[aOR]4.30[95%置信区间[CI]2.11 - 9.04]，P<0.001）更有可能与合适的TEE使用相关。在204次TEE使用中，根据ESC推荐，只有80次（39.2%）被认为是合适的。根据ESC推荐，有静脉药物使用史（aOR 3.08[95%CI 1.08 - 9.27]，P = 0.04）以及血培养IE相关病原体阳性（aOR 2.31[95%CI 1.16 - 4.80]，P = 0.02）更有可能与合适的TEE使用相关。
本研究表明，TEE在IE诊断中的应用对ACCF和ASE以及ESC发布的推荐的遵循程度各不相同，两者之间存在显著差异。
