Abstract
Background: The clinical impact of echocardiographic demonstration of a vegetation (Veg) in patients in whom infective endocarditis (IE) is not suspected has not previously been analyzed.
Hypothesis: In this study, an echocardiographic database was interrogated to test whether discovery of a vegetation by echocardiography should result in treatment for endocarditis if IE is not suspected.
Methods: In all, 2,750 serial transthoracic echocardiograms (TTE) were reviewed to generate a list of reports containing the word Veg or thickening (Thk). A chart review of cases identified the impact the report had on patient management. To analyze reader bias due to echocardiographic requests, stating “rule out Veg or IE” as the reason for the study, an additional 1,000 serial TTE requests were segregated into two groups with and without this term. The incidence of the terms Veg or Thk in TTE reports of these groups was tabulated.
Results: Of 2,750 reports, 20 contained the word Veg. Blood cultures were drawn in 16 of 20, with 7 of 16 being positive. Therapy for IE was initiated in 5 of 7 patients with positive cultures. Of 1,000 requests reviewed in the second phase, 24% of those with rule out Veg as the indication for TTE (n = 29) had Veg and 7% had Thk, while in 971 cases with other indications for TTE 0.2% had Veg and 9.3% had Thk.
Conclusions: Clinicians disregard TTE demonstration of Veg if clinical suspicion for IE is low. It is not clear whether the initial echo request biases the interpretation.
Keywords: infective endocarditis, vegetation, transthoracic echocardiography, valve thickening
Full Text
The Full Text of this article is available as a PDF (313.6 KB).
References
- 1. Osler W: Malignant endocarditis. Lancet 1885; 1: 415–430 [Google Scholar]
- 2. Osler W: Chronic infective endocarditis. QJ Med 1909; 2: 219–230 [Google Scholar]
- 3. Markiewicz W, Peled B, Alroy G, Pollack S, Brook G, Rapoport J, Kerner H: Echocardiography in infective endocarditis. Lack of specificity in patients with valvular pathology. Eur J Cardiol 1979; 10 (4): 247–257 [PubMed] [Google Scholar]
- 4. Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB: Diagnostic value of transesophageal echocardiography compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol 1981; 18,2: 391–397 [DOI] [PubMed] [Google Scholar]
- 5. Mugge A, Daniel WG, Frank G, Lichtlen PR: Echocardiography in infective endocarditis: Reassessment of prognostic implications of vegetation sie determined by the transthoracic and transesophageal approach. J Am Coll Cardiol 1989; 14,3: 631–638 [DOI] [PubMed] [Google Scholar]
- 6. Linder JR, Case AR, Dent JM, Abbott RD, Scheld WM, Kaul S: Diagnostic value of echocardiography in suspected endocarditis. An evaluation based on the pretest probability of disease. Circulation 1996; 93,4: 730–736 [DOI] [PubMed] [Google Scholar]