Analysis of Transesophageal Echocardiography Appropriateness for Diagnosing Infective Endocarditis: Insights From Two Tertiary-Care Hospitals

Abstract

Background

Echocardiography plays a key role in the diagnosis of infective endocarditis (IE), and recommendations have been published regarding the appropriate use of transesophageal echocardiography (TEE). The objective of this study is to evaluate the utilization of TEE in Regina, Saskatchewan, in the diagnosis of IE.

Methods

A retrospective chart review was performed on patients aged ≥ 18 years who received a TEE test for the diagnosis of IE from January 1 to December 31, 2019. The primary outcome included the proportion of TEE uses that complied with the American College of Cardiology Foundation and American Society of Echocardiography (ACCF and ASE) recommendations and the European Society of Cardiology (ESC) recommendations.

Results

A total of 204 admissions involving 188 patients who had TEE performed for the diagnosis of IE occurred within the study period. The mean age was 53.1 ± 17.1 years. Of the 204 TEE uses, 152 (74.5%) were considered appropriate by the ACCF and ASE recommendations. Having at least one predisposing condition (adjusted odds ratio [aOR] 4.30 [95% confidence interval [CI] 2.11-9.04), P < 0.001]) was more likely to be associated with appropriate TEE use, per the ACCF and ASE criteria. Of the 204 TEE uses, only 80 (39.2%) were considered appropriate by the ESC recommendations. Having a history of intravenous drug use (aOR 3.08 [95% CI 1.08-9.27], P = 0.04) and having blood cultures positive for IE-related organisms (aOR 2.31 [95% CI 1.16-4.80], P = 0.02)) were more likely to be associated with appropriate TEE use, per ESC recommendations.

Conclusions

The current study suggests that the use of TEE in the diagnosis of IE demonstrated variable levels of adherence to recommendations published by the ACCF and ASE and by the ESC, with significant discrepancy between the two.