Progress in CardiologyClinical information determines the impact of transesophageal echocardiography on the diagnosis of infective endocarditis by the Duke criteria☆,☆☆
Section snippets
Patient selection
An endocarditis database was established at Duke University Medical Center (DUMC) in October 1988 to include all patients with suspected IE evaluated at DUMC. The study population consisted of patients in the Duke endocarditis database from October 1988 to December 1995 who had at least one TTE and TEE examination performed within a 7-day period during their initial evaluation at DUMC. A total of 567 patients were in the database at the time this study was undertaken. Patients with recurrent
Patient characteristics
A total of 112 patients with 114 episodes of suspected IE underwent both TTE and TEE examinations during the study period. Native cardiac valves were present in 80 (70%) of the episodes of suspected IE, and 1 or more prosthetic cardiac valves was present in 34 (30%) of the episodes. A category reassignment occurred when TEE results were incorporated into the diagnostic evaluation with the Duke criteria in 25 of the 114 episodes evaluated. The remaining 89 episodes of suspected IE were
Discussion
By using a classification system based on the Duke criteria for IE and TTE findings, we found that TEE findings resulted in important changes in the diagnostic classification in almost 25% of the patients evaluated. Although only 11% of patients with native valves were reclassified to a new diagnostic category with TEE findings, 34% of patients with prosthetic valves were reclassified. The majority of patients who were reclassified to a new category were diagnosed with definite IE on the basis
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Guest Editor for this manuscript was William F. Armstrong, MD, University of Michigan, Ann Arbor.
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Reprint requests: Matthew T. Roe, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail: [email protected]