Almeida J, Sepúlveda F, Cruz A, Proença L, Gomes M R
Centro de Cirurgia Torácica, Hospital de S. João, Porto.
Rev Port Cardiol. 1994 May;13(5):397-402, 380.
The aim of this study is to compare the performance of Transesophageal Echocardiography (TEE) and the Transthoracic approach (TTE) in the diagnosis of Infectious Endocarditis (IE). Between October/90, the data we started transesophageal ultrasound, till April/92, we performed 33 TTE in inpatients with clinical suspicion of IE. Twenty pts (61%) had one or two prosthesis. All the pts had a previous TTE. The diagnosis of IE determined by non-echocardiographic data was established on 18 pts. The other 15 pts, without clinical criteria of IE, were used as the control group. The Echocardiographic criteria for the diagnosis of IE were for both diagnostic tools the presence of masses suggesting vegetation of abscess. The diagnosis was correctly made by TTE in 8 of the 18 pts (S-44%) and by TEE in 16 of the 18 pts (S-89%) with clinical criteria for IE. Of the 15 patients without clinical criteria for IE 14 were correctly identified by TTE (Sp-93%) and 13 by TEE (Sp-89%). With a similar VPP (89%) for both tools has TEE a significative higher value for NPV than TTE (87% vs 58%). This study suggests that TEE, at a same level of specificity as TTE, is highly more sensitive in the diagnosis of IE (S-89 14 for TEE and S-44 23 for TTE) a figure that recommends that all patients with clinical suspicion of IE and a negative TTE should perform a TEE.
本研究旨在比较经食管超声心动图（TEE）和经胸超声心动图（TTE）在感染性心内膜炎（IE）诊断中的表现。从1990年10月开始进行经食管超声检查，至1992年4月，我们对临床怀疑患有IE的住院患者进行了33次TTE检查。20例患者（61%）有一个或两个心脏瓣膜假体。所有患者之前均接受过TTE检查。根据非超声心动图数据确诊为IE的患者有18例。另外15例无IE临床标准的患者作为对照组。两种诊断工具诊断IE的超声心动图标准均为存在提示赘生物或脓肿的团块。在有IE临床标准的18例患者中，TTE正确诊断出8例（敏感性-44%），TEE正确诊断出16例（敏感性-89%）。在15例无IE临床标准的患者中，TTE正确识别出14例（特异性-93%），TEE正确识别出13例（特异性-89%）。两种检查方法的阳性预测值（VPP）相似（均为89%），但TEE的阴性预测值（NPV）显著高于TTE（87%对58%）。本研究表明，在特异性相同的情况下，TEE在IE诊断中的敏感性更高（TEE敏感性为89%，TTE为44%），这表明所有临床怀疑患有IE且TTE检查结果为阴性的患者都应接受TEE检查。
