Cormier B, Diebold B, Guéret P, Roudaut R
Service de cardiologie, hôpital Tenon, Paris.
Arch Mal Coeur Vaiss. 1993 Dec;86(12 Suppl):1819-23.
This cooperative study recensed 148 patients who had infective endocarditis (IE) with anatomopathological correlations. The infection was on native valves in 89 cases and prosthetic valves in 59 cases. Transoesophageal echocardiography diagnosed vegetations on native valves with a sensitivity, specificity, positive predictive and negative predictive values of 89%, 87%, 88% and 90% respectively, whereas for transthoracic echocardiography the results were 68%, 83%, 81% and 72% respectively. With respect to prosthetic valve vegetations, transoesophageal echocardiography had a sensitivity, specificity, positive predictive and negative predictive values of 67%, 84%, 48% and 92% respectively compared with 56%, 84%, 44% and 83% respectively for transthoracic echocardiography. These results underline the difficulties in differentiating degeneration and endocarditis of bioprostheses. Transoesophageal echocardiography diagnosed aneurysm formation and valvular perforation with a sensitivity, specificity, positive and negative predictive values of 61%, 93%, 91% and 72% respectively compared with 35%, 96%, 98% and 58% respectively for transthoracic echocardiography. The false negative results of transoesophageal echocardiography were usually observed in lesions of the posterior leaflet or commissures. In this series, the 6 aortic cusp perforations were undiagnosed by both transthoracic and transoesophageal echocardiography. With respect to aortic ring abscess, the sensitivity, specificity, positive and negative predictive values of transoesophageal echocardiography were 89%, 100%, 100% and 93% respectively, compared with 27%, 100%, 100% and 62% for transthoracic echocardiography. The false negative results of transoesophageal echocardiography were observed in cases of anterior abscesses or of calcific aortic valves. These results demonstrate the superiority of transesophageal over transthoracic echocardiography in the diagnosis of infective endocarditis and its complications. However, the limitations of the method should be recognized in the situations described.
这项合作研究纳入了148例有解剖病理学关联的感染性心内膜炎（IE）患者。89例感染发生在自身瓣膜，59例发生在人工瓣膜。经食管超声心动图诊断自身瓣膜赘生物的敏感性、特异性、阳性预测值和阴性预测值分别为89%、87%、88%和90%，而经胸超声心动图的结果分别为68%、83%、81%和72%。对于人工瓣膜赘生物，经食管超声心动图的敏感性、特异性、阳性预测值和阴性预测值分别为67%、84%、48%和92%，经胸超声心动图的结果分别为56%、84%、44%和83%。这些结果凸显了区分生物瓣膜退变和心内膜炎的困难。经食管超声心动图诊断动脉瘤形成和瓣膜穿孔的敏感性、特异性、阳性和阴性预测值分别为61%、93%、91%和72%，经胸超声心动图的结果分别为35%、96%、98%和58%。经食管超声心动图的假阴性结果通常见于后叶或瓣叶联合处的病变。在本系列研究中，6例主动脉瓣叶穿孔经胸和经食管超声心动图均未诊断出来。对于主动脉环脓肿，经食管超声心动图的敏感性、特异性、阳性和阴性预测值分别为89%、100%、100%和93%，经胸超声心动图的结果分别为27%、100%、100%和62%。经食管超声心动图的假阴性结果见于前部脓肿或钙化性主动脉瓣病例。这些结果表明，在感染性心内膜炎及其并发症的诊断中，经食管超声心动图优于经胸超声心动图。然而，在所述情况下应认识到该方法的局限性。
