JCM, Vol. 14, Pages 2195: Transthoracic Echocardiography in Assessing Patients with Suspected Infective Endocarditis (TEASE): An Exploratory Study

Greenberg March 24, 2025 in News - 2 Minutes

JCM, Vol. 14, Pages 2195: Transthoracic Echocardiography in Assessing Patients with Suspected Infective Endocarditis (TEASE): An Exploratory Study

Journal of Clinical Medicine doi: 10.3390/jcm14072195

Authors:
Nello Cambise
Saverio Tremamunno
Angelo Giuseppe Marino
Ludovica Lenci
Fabio De Benedetto
Antonietta Belmusto
Lorenzo Tinti
Antonio Di Renzo
Federico Di Perna
Giacomo Buonamassa
Sara Pontecorvo
Antonio De Vita
Massimiliano Camilli
Francesca Augusta Gabrielli
Francesca Graziani
Priscilla Lamendola
Gabriella Locorotondo
Rosaria Natali
Antonella Lombardo
Gaetano Antonio Lanza

Background: An extensive use of transesophageal echocardiography (TEE) has recently been suggested for the diagnosis of infective endocarditis (IE). In this study, we investigated whether among patients with negative transthoracic echocardiography (TTE), subgroups can be identified among whom TEE can be avoided/delayed. Methods: We conducted a retrospective study of 637 consecutive patients who underwent TEE for suspected IE. We selected 375 patients with negative TTE. For each patient, we obtained age, sex, blood culture (BC), blood exams, evidence of embolism, presence of moderate/severe heart valve disease, valve prostheses, and intracardiac devices. Results: IE was eventually diagnosed in 56 patients. Variables independently associated with IE at multivariate analysis included positive BC (OR 3.45; p = 0.006), evidence of embolism (OR 13.0; p &lt; 0.001), bioprosthetic heart valves (OR 4.31; p &lt; 0.001) and platelet count &lt; 150,000/mL (OR 2.47; p = 0.014). In patients without any of these predictors for IE (n = 81), only 1 had a diagnosis of IE and no in-hospital IE-related deaths occurred. Among patients with negative BC (n = 127), IE prevalence increased with the number of other predictors, but IE-related mortality was 0%. IE prevalence (10.8%) and IE related in-hospital mortality (2.7%) were also rather low in patients with a positive blood culture without any other independent predictors for IE but were 20% (IE-related mortality 3.8%) and 71% (IE-related mortality 28.6%) in those with only one or 2&ndash;3 other IE predictors, respectively. Conclusions: Our data suggest that, among patients with suspected IE and negative TTE, subgroups can be identified in whom TEE might be safely avoided or delayed.

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