Maisch B, Drude L
Department of Internal Medicine and Cardiology, Philipps-University Marburg.
Herz. 1993 Dec;18(6):341-60.
Echocardiography has contributed considerably to the evolution in the management of patients with infective endocarditis. There is a clear hierarchy with respect to sensitivity of the different methods is superior when compared to 2-D and M-mode echocardiography in identifying both vegetations and perivalvular complications e.g. abscess formation, aneurysms, mural endocardial lesions. For patients with suspected endocarditis, in whom vegetations can not be clearly identified or in whom abscess formation is suspected with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) with mono- or multiplane scans has become the standard diagnostic procedure. For the examination of prosthetic valves it is the method of choice. It has even been suggested that it is employed as routine measure in all patients with suspected infective endocarditis. TEE is a safe semi-invasive technique with an extremely low complication rate and high sensitivity. Its specificity depends largely on the patient group which is examined. In patients with indicative clinical symptoms the specificity and the predictive value of vegetations are high. When used as screening method to assess echodense formations at cardiac valves particularly in the elderly, in whom degenerative changes prevail, its specificity and positive predictive value of vegetation-like structures are much lower. The negative predictive value of a negative transesophageal echocardiogram remains high, however. Valve abscesses are detected rarely by transthoracic echocardiography. It is the domain of TEE to assess them particularly in the aortic and mitral valve area. For them the specificity and positive predictive value of TEE in the diagnosis of infective endocarditis is high again. Of further importance was the observation that patients with vegetations of > 10 mm were more likely to suffer embolic complications. It should be noted, however, that infective endocarditis remains a clinical diagnosis: neither is the demonstration of a vegetation already the equivalent of endocarditis, nor does missing vegetations completely rule out the possibility of it. But without doubt, the presence of vegetations, of abscess formation or a concomitant pericardial effusion add valuable information to clinical diagnosis of infective endocarditis, which still needs a "high index of suspicion".
超声心动图对感染性心内膜炎患者的治疗进展贡献显著。不同方法在识别赘生物和瓣周并发症（如脓肿形成、动脉瘤、壁层心内膜病变）方面的敏感性存在明显的层级关系，在这方面，[具体方法名称]与二维和M型超声心动图相比更具优势。对于疑似心内膜炎的患者，如果经胸超声心动图（TTE）无法清晰识别赘生物或怀疑有脓肿形成，采用单平面或多平面扫描的经食管超声心动图（TEE）已成为标准诊断程序。对于人工瓣膜的检查，它是首选方法。甚至有人建议，在所有疑似感染性心内膜炎的患者中都应将其作为常规检查手段。TEE是一种安全的半侵入性技术，并发症发生率极低且敏感性高。其特异性很大程度上取决于所检查的患者群体。在有典型临床症状的患者中，赘生物的特异性和预测价值较高。当用作筛查方法来评估心脏瓣膜上的回声致密结构时，尤其是在以退行性变为主的老年人中，其对类似赘生物结构的特异性和阳性预测价值要低得多。然而，经食管超声心动图检查结果为阴性时的阴性预测价值仍然很高。经胸超声心动图很少能检测到瓣膜脓肿。评估瓣膜脓肿尤其是在主动脉瓣和二尖瓣区域，是TEE的优势领域。对于瓣膜脓肿，TEE在感染性心内膜炎诊断中的特异性和阳性预测价值再次很高。另一个重要的观察结果是，赘生物大于10毫米的患者更易发生栓塞并发症。然而，应该注意的是，感染性心内膜炎仍然是一种临床诊断：赘生物的发现并不等同于心内膜炎，没有发现赘生物也不能完全排除心内膜炎的可能性。但毫无疑问，赘生物、脓肿形成或伴有心包积液的存在为感染性心内膜炎的临床诊断增添了有价值的信息，而感染性心内膜炎的临床诊断仍需要“高度的怀疑指数”。
