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Judicious use of transthoracic echocardiography in the diagnosis of infective endocarditis
  1. P Robles
  1. Correspondence to:
    Dr Pablo Robles, Avda Ebanos 44, 3E B Getafe, MA, Spain;

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Patients with a very low clinical probability of infective endocarditis do not benefit from echocardiography—but what is the definition of “very low probability”?

The diagnosis of infective endocarditis (IE) requires the integration of clinical, laboratory, and echocardiographic data. During the past two decades, various clinical criteria have been proposed and subsequently modified for the diagnosis of IE. In 1994 a group at Duke University proposed standardised criteria for assessing patients with suspected IE.1 These criteria integrated factors predisposing patients to the development of IE, the blood culture isolate and persistence of bacteraemia, and echocardiographic findings with other clinical and laboratory information. The usefulness of these Duke criteria in assessing patients with potential IE has been validated in several subsequent studies.2

Transthoracic echocardiography (TTE) is rapid and non-invasive and has excellent specificity for vegetations. According to the population studied, TTE has been reported to have a sensitivity of 40–80% for the detection of vegetations.3 Because of the possibility of a false negative examination (or the absence of a vegetation) or a false positive study (Lambl’s excrescenses, non-infective vegetations, thrombi), echocardiography should not supplant clinical and microbiological diagnosis. TTE views may be inadequate in up to 20% of adult patients …

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