Cambise Nello, Tremamunno Saverio, Marino Angelo Giuseppe, Lenci Ludovica, De Benedetto Fabio, Belmusto Antonietta, Tinti Lorenzo, Di Renzo Antonio, Di Perna Federico, Buonamassa Giacomo, Pontecorvo Sara, De Vita Antonio, Camilli Massimiliano, Gabrielli Francesca Augusta, Graziani Francesca, Lamendola Priscilla, Locorotondo Gabriella, Natali Rosaria, Lombardo Antonella, Lanza Gaetano Antonio
Dipartimento di Scienze Cardiovascolari e del Torace, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy.
J Clin Med. 2025 Mar 24;14(7):2195. doi: 10.3390/jcm14072195.
: An extensive use of transesophageal echocardiography (TEE) has recently been suggested for the diagnosis of infective endocarditis (IE). In this study, we investigated whether among patients with negative transthoracic echocardiography (TTE), subgroups can be identified among whom TEE can be avoided/delayed. : We conducted a retrospective study of 637 consecutive patients who underwent TEE for suspected IE. We selected 375 patients with negative TTE. For each patient, we obtained age, sex, blood culture (BC), blood exams, evidence of embolism, presence of moderate/severe heart valve disease, valve prostheses, and intracardiac devices. : IE was eventually diagnosed in 56 patients. Variables independently associated with IE at multivariate analysis included positive BC (OR 3.45; = 0.006), evidence of embolism (OR 13.0; < 0.001), bioprosthetic heart valves (OR 4.31; < 0.001) and platelet count < 150,000/mL (OR 2.47; = 0.014). In patients without any of these predictors for IE ( = 81), only 1 had a diagnosis of IE and no in-hospital IE-related deaths occurred. Among patients with negative BC ( = 127), IE prevalence increased with the number of other predictors, but IE-related mortality was 0%. IE prevalence (10.8%) and IE related in-hospital mortality (2.7%) were also rather low in patients with a positive blood culture without any other independent predictors for IE but were 20% (IE-related mortality 3.8%) and 71% (IE-related mortality 28.6%) in those with only one or 2-3 other IE predictors, respectively. : Our data suggest that, among patients with suspected IE and negative TTE, subgroups can be identified in whom TEE might be safely avoided or delayed.
最近有人建议广泛使用经食管超声心动图（TEE）来诊断感染性心内膜炎（IE）。在本研究中，我们调查了在经胸超声心动图（TTE）结果为阴性的患者中，是否可以识别出可避免/延迟进行TEE检查的亚组。
我们对637例因疑似IE接受TEE检查的连续患者进行了一项回顾性研究。我们选择了375例TTE结果为阴性的患者。对于每位患者，我们获取了年龄、性别、血培养（BC）、血液检查、栓塞证据、中重度心脏瓣膜病、瓣膜假体和心内装置的情况。
最终有56例患者被诊断为IE。多变量分析中与IE独立相关的变量包括血培养阳性（OR 3.45；P = 0.006）、栓塞证据（OR 13.0；P < 0.001）、生物人工心脏瓣膜（OR 4.31；P < 0.001）和血小板计数<150,000/mL（OR 2.47；P = 0.014）。在没有这些IE预测因素的患者中（n = 81），只有1例被诊断为IE，且没有发生院内与IE相关的死亡。在血培养阴性的患者中（n = 127），IE患病率随其他预测因素的数量增加而升高，但IE相关死亡率为0%。在血培养阳性但没有其他IE独立预测因素的患者中，IE患病率（10.8%）和院内IE相关死亡率（2.7%）也相当低，但在只有一个或两三个其他IE预测因素的患者中，患病率分别为20%（IE相关死亡率3.8%）和71%（IE相关死亡率28.6%）。
我们的数据表明，在疑似IE且TTE结果为阴性的患者中，可以识别出可能安全地避免或延迟进行TEE检查的亚组。
