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Repeated echocardiography after the diagnosis of endocarditis: too much of a good thing?
  1. C H Cabell,
  2. V G Fowler Jr
  1. Department of Medicine, Duke University School of Medicine, and the Duke Clinical Research Institute, Durham, North Carolina, USA
  1. Correspondence to:
    Dr Christopher H Cabell
    Box 3850, Duke University Medical Center, Durham, NC 27710, USA;

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Although echocardiography is seen as the technology of choice for the diagnosis of infective endocarditis, it is being increasingly overused in clinical scenarios with a low pre-test probability of disease

Since the advent of two dimensional transthoracic echocardiography (TTE) in the 1970s and high frequency transoesophageal echocardiography (TOE) imaging in the 1980s, echocardiography has become a standard diagnostic tool in patients with suspected infective endocarditis (IE). It is now well established that echocardiography is a technology of choice for the diagnosis of IE,1 and that echocardiography can detect cardiac involvement in a significant proportion of patients with clinically occult IE.2,3 Because IE is a lethal infection that can be difficult to diagnose clinically, clinicians who care for patients at risk for IE often have a low threshold for employing echocardiography. This clinical practice has several implications. While echocardiography can often provide a rapid diagnosis, its optimal use is predicated on the appropriate pre-test probability of disease.4,5 By contrast, echocardiography is increasingly overused in clinical scenarios with a low (< 2–3%) pre-test probability of disease, where its diagnostic utility diminishes.6,7

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