Echo and IE

Q: For infective endocarditis (IE)Transthoracic echocardiography (TTE) has higher? (select one)

A) sensitivity

B) specificity

Answer: B

As per European Society of Cardiology (ESC) Guidelines, the estimated sensitivity of TTE for IE is around 70 percent for native valves and 50 percent for prosthetic valves. If noted, the specificity is around 90 percent. The visualization of vegetation can be compromised by thick chest wall (obesity), underlying valve thickening, valve calcification, redundant leaflet tissue, prosthetic shadowing, small vegetation or vegetation which has embolized. 

Interestingly, this is reverse for transesophageal echocardiography (TEE) due to better/clear visualization. TEE yields sensitivity of about 96 percent for native valves and 92 percent for prosthetic valves, and the specificity for both is about 90 percent.

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References:

1. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075.

2. Bai AD, Steinberg M, Showler A, et al. Diagnostic Accuracy of Transthoracic Echocardiography for Infective Endocarditis Findings Using Transesophageal Echocardiography as the Reference Standard: A Meta-Analysis. J Am Soc Echocardiogr 2017; 30:639.