BACKGROUND: Patients with a very low probability of infective endocarditis (IE) do not benefit from transthoracic echocardiography (TTE). Because the term 'very low probability' has not yet been defined, the present prospective study sought to identify the population with a 'very low probability'. METHODS: TTE was performed between July 2005 and October 2006 in consecutive patients clinically suspected of having IE. Clinical parameters suggestive of IE and presence of infectious focus were recorded. RESULTS: Twenty-four (15.5%) of 155 patients studied had positive findings on TTE. Significant positive predictors were embolic events, intravenous drug use, the presence of a prosthetic valve, positive blood cultures and immunological phenomena. The significant negative predictor was confirmed infection sites other than endocardium. Sixty-three (40.6%) of 155 patients without positive predictors were found to have no vegetation. Thus, the collective absence of these predictors indicated a zero probability of TTE showing evidence of IE. A significant negative predictor was a definite etiology of infection other than IE. Only one in 76 patients was diagnosed with both IE and infection at another site. CONCLUSIONS: The absence of positive predictors or the presence of a negative predictor indicate a near-zero probability of IE being detected by TTE. Use of clinical parameters may avoid up to 41% of unnecessary TTE examinations, increasing the likelihood that such a diagnosis will be correct.
BACKGROUND:Patients with a very low probability of infective endocarditis (IE) do not benefit from transthoracic echocardiography (TTE). Because the term 'very low probability' has not yet been defined, the present prospective study sought to identify the population with a 'very low probability'. METHODS: TTE was performed between July 2005 and October 2006 in consecutive patients clinically suspected of having IE. Clinical parameters suggestive of IE and presence of infectious focus were recorded. RESULTS: Twenty-four (15.5%) of 155 patients studied had positive findings on TTE. Significant positive predictors were embolic events, intravenous drug use, the presence of a prosthetic valve, positive blood cultures and immunological phenomena. The significant negative predictor was confirmed infection sites other than endocardium. Sixty-three (40.6%) of 155 patients without positive predictors were found to have no vegetation. Thus, the collective absence of these predictors indicated a zero probability of TTE showing evidence of IE. A significant negative predictor was a definite etiology of infection other than IE. Only one in 76 patients was diagnosed with both IE and infection at another site. CONCLUSIONS: The absence of positive predictors or the presence of a negative predictor indicate a near-zero probability of IE being detected by TTE. Use of clinical parameters may avoid up to 41% of unnecessary TTE examinations, increasing the likelihood that such a diagnosis will be correct.
Authors: Dieter Horstkotte; Ferenc Follath; Erno Gutschik; Maria Lengyel; Ali Oto; Alain Pavie; Jordi Soler-Soler; Gaetano Thiene; Alexander von Graevenitz; Silvia G Priori; Maria Angeles Alonso Garcia; Jean-Jacques Blanc; Andrzej Budaj; Martin Cowie; Veronica Dean; Jaap Deckers; Enrique Fernández Burgos; John Lekakis; Bertil Lindahl; Gianfranco Mazzotta; João Morais; Ali Oto; Otto A Smiseth; John Lekakis; Alec Vahanian; François Delahaye; Alexander Parkhomenko; Gerasimos Filipatos; Jan Aldershvile; Panos Vardas Journal: Eur Heart J Date: 2004-02 Impact factor: 29.983
Authors: A S Bayer; A F Bolger; K A Taubert; W Wilson; J Steckelberg; A W Karchmer; M Levison; H F Chambers; A S Dajani; M H Gewitz; J W Newburger; M A Gerber; S T Shulman; T J Pallasch; T W Gage; P Ferrieri Journal: Circulation Date: 1998 Dec 22-29 Impact factor: 29.690
Authors: M D Cheitlin; J S Alpert; W F Armstrong; G P Aurigemma; G A Beller; F Z Bierman; T W Davidson; J L Davis; P S Douglas; L D Gillam; R P Lewis; A S Pearlman; J T Philbrick; P M Shah; R G Williams; J L Ritchie; K A Eagle; T J Gardner; A Garson; R J Gibbons; R A O'Rourke; T J Ryan Journal: J Am Coll Cardiol Date: 1997-03-15 Impact factor: 24.094
Authors: R Erbel; S Rohmann; M Drexler; S Mohr-Kahaly; C D Gerharz; S Iversen; H Oelert; J Meyer Journal: Eur Heart J Date: 1988-01 Impact factor: 29.983