Clinical impact of transesophageal echocardiography in the diagnosis and management of infective endocarditis.

Transesophageal echocardiography (TEE) has assumed a prominent role in the diagnosis and management of infective endocarditis (IE). The impact of negative TEE findings on the management of patients suspected of having IE is not clear. To better understand how a negative TEE examination would influence patient management, the medical records of 93 consecutive patients undergoing TEE to evaluate for IE were examined. The influence of TEE was assessed based on changes in diagnosis, antibiotic therapy, or the need for surgical intervention during hospitalization. The negative predictive value of TEE was found to be 100% in native valves and 90% in prosthetic valves. The overall impact of negative TEE findings was significant in terms of final diagnosis and duration of antibiotic therapy (a negative TEE resulted in 60% reduction in antibiotic duration, p = 0.0001). These findings suggest that in patients with native heart valves, a negative TEE examination virtually excludes IE. In patients with prosthetic valves, a negative TEE significantly decreases the likelihood of IE but does not completely exclude the diagnosis; therefore, in this setting, a negative finding should be closely correlated with the clinical course.