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Clinical criteria and the appropriate use of transthoracic echocardiography for the exclusion of infective endocarditis
  1. K Greaves,
  2. D Mou,
  3. A Patel,
  4. D S Celermajer
  1. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, and Department of Medicine, University of Sydney, Australia
  1. Correspondence to:
    Professor David S Celermajer, Cardiology Department, Royal Prince Alfred Hospital, Page Chest Pavilion Building, Missenden Road, Camperdown, Sydney, NSW 2050, Australia;


Background: Clinical guidelines currently suggest that transthoracic echocardiography (TTE) be carried out in all patients with suspected endocarditis, but the use of TTE where there is a low probability of infective endocarditis has a poor diagnostic yield. This screening approach may no longer be appropriate.

Objective: To examine whether clinical criteria might aid decision making with respect to the use of TTE in possible endocarditis.

Design: A retrospective review of patient records.

Setting: Cardiology department of a tertiary referral centre.

Patients: 500 consecutive hospital inpatients referred for TTE to exclude endocarditis.

Main outcome measures: Evidence of endocardial vegetations on TTE and the presence of predetermined clinical criteria that may predispose to, or be suggestive of, endocarditis.

Results: Evidence of infective endocarditis was detected on echocardiography in 43 of the 500 patients (8.6%). In 239 patients (48%), vegetations and certain prespecified clinical criteria were both absent. These criteria were: vasculitic/embolic phenomena; the presence of central venous access; a recent history of injected drug use; presence of a prosthetic valve; and positive blood cultures. The collective absence of these five criteria indicated a zero probability of TTE showing evidence of endocarditis.

Conclusions: The use of simple clinical criteria during the decision making process may avoid many unnecessary TTE examinations in hospital inpatients with a low probability of endocarditis.

  • endocarditis
  • echocardiography

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