Repeat Echo in IE

Q: A 56-year-old male with PMH of end-stage renal disease (ESRD) is recovering in the ICU after a bout of infective endocarditis (IE), while cardiac surgery is considering valve replacement. A repeat echocardiogram is warranted to determine the evolving size of the vegetation.

A) True

B) False

Answer: B

Repeating an 'echo' to determine change in vegetation size or based on the pathogen is not recommended. 'Echo' is highly overused in IE follow-ups.

Echocardiogram, either transthoracic or transesophageal, should be repeated only if a new complication or a clinical change occurs, such as:

• a new murmur
• suspicion of embolic phenomenon
• new or worsening heart failure
• atrioventricular block
• persistent fever 
• persistent bacteremia 
• Switching antibiotics to oral

#cardiology

#ID

References:

1. Tzimas G, Monney P, Antiochos P, Auberson D, Ianculescu N, Guery B, Niclauss L, Kirsch M, Papadimitriou-Olivgeris M. Real-World Diagnostic Performance of Repeat Transthoracic Echocardiography Within a Multimodality Imaging Approach in Patients With Suspected Infective Endocarditis. J Am Heart Assoc. 2026 Aug 18;15(16):e050020. doi: 10.1161/JAHA.126.050020. Epub 2026 Aug 7. PMID: 42568077.

2. Cabell CH, Fowler VG Jr. Repeated echocardiography after the diagnosis of endocarditis: too much of a good thing? Heart. 2004 Sep;90(9):975-6. doi: 10.1136/hrt.2003.031328. PMID: 15310673; PMCID: PMC1768410.

3. Greco CA, Zaccaria S, Casali G, Nicolardi S, Albanese M. Echocardiography in Endocarditis. Echocardiography. 2024 Oct;41(10):e15945. doi: 10.1111/echo.15945. PMID: 39432316.