IMPROVEMENT IN THE DIAGNOSIS OF ABSCESSES ASSOCIATED WITH ENDOCARDITIS BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY
IMPROVEMENT IN THE DIAGNOSIS OF ABSCESSES ASSOCIATED WITH ENDOCARDITIS BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY
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DOI：
10.1056/nejm199103213241203
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发表时间：
1991-03-21
影响因子：
158.5
通讯作者：
LICHTLEN, PR
中科院分区：
文献类型：
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作者：
DANIEL, WG;MUGGE, A;LICHTLEN, PR
背景资料。超声心动图被认为是无创检测感染性心内膜炎患者瓣膜赘生物的首选方法，其中经食道超声心动图比经胸超声心动图更准确。然而，在许多情况下，经胸超声心动图诊断相关脓肿是困难的，甚至是不可能的，而且尚不清楚经食道超声心动图是否更好。为了确定经食道超声心动图在检测与心内膜炎相关的脓肿中的价值，我们通过二维经胸和经食道超声心动图对连续118例感染性心内膜炎患者进行前瞻性研究，这些患者均为137例手术中或尸检证实的人工瓣膜或人工瓣膜。在手术或尸检中，44名患者(37.3%)总共有46个明确的脓肿区域。主动脉瓣心内膜炎患者的脓肿发生率高于其他瓣膜感染患者，脓肿患者的感染菌以葡萄球菌为主(52.3%)，而无脓肿患者的感染率为16.2%。有脓肿患者的医院死亡率为22.7%，而没有脓肿患者的医院死亡率为13.5%。虽然经胸超声心动图只发现了46个脓肿区域中的13个，但经食道途径可以检测到40个区域(P<；0.001)。经胸超声心动图和经食道超声心动图诊断心内膜炎相关脓肿的敏感性和特异性分别为28.3%和98.6%和87.0%和94.6%，阳性预测值和阴性预测值分别为92.9%和68.9%，经食道途径分别为90.9%和92.1%。观察者之间经胸超声心动图的变异为3.4%，经食道超声心动图为4.2%。这些数据表明，经食道超声心动图对心内膜炎相关脓肿的诊断有显著改善。这项技术有助于识别死亡风险增加的心内膜炎患者，并允许更早的治疗。
Background. Echocardiography is recognized as the method of choice for the noninvasive detection of valvular vegetations in patients with infective endocarditis, with transesophageal echocardiography being more accurate than transthoracic echocardiography. The diagnosis of associated abscesses by transthoracic echocardiography is difficult or even impossible in many cases, however, and it is not known whether transesophageal echocardiography is any better.Methods. To determine the value of transesophageal echocardiography in the detection of abscesses associated with endocarditis, we studied prospectively by two-dimensional transthoracic and transesophageal echocardiography 118 consecutive patients with infective endocarditis of 137 native or prosthetic valves that was documented during surgery or at autopsy.Results. During surgery or at autopsy, 44 patients (37.3 percent) had a total of 46 definite regions of abscess. Abscesses were more frequent in aortic-valve endocarditis than in infections of other valves, and the infecting organism was more often staphylococcus (52.3 percent of cases) in patients with abscesses than in those without abscesses (16.2 percent). The hospital mortality rate was 22.7 percent in patients with abscesses, as compared with 13.5 percent in patients without abscesses. Whereas transthoracic echocardiography identified only 13 of the 46 areas of abscess, the transesophageal approach allowed the detection of 40 regions (P < 0.001). Sensitivity and specificity for the detection of abscesses associated with endocarditis were 28.3 and 98.6 percent, respectively, for transthoracic echocardiography and 87.0 and 94.6 percent for transesophageal echocardiography; positive and negative predictive values were 92.9 and 68.9 percent, respectively, for the transthoracic approach and 90.9 and 92.1 percent for the transesophageal approach. Variation between observers was 3.4 percent for transthoracic and 4.2 percent for transesophageal echocardiography.Conclusions. The data indicate that transesophageal echocardiography leads to a significant improvement in the diagnosis of abscesses associated with endocarditis. The technique facilitates the identification of patients with endocarditis who have an increased risk of death and permits earlier treatment.