Can transthoracic echocardiography be used to a greater extent in the diagnostics of infective endocarditis to avoid unnecessary transoesophageal examinations without jeopardising accuracy?

Table 3 Indications for TOE according to international recommendations for echocardiographic management of IE

Indication for TOE	All TOE examinations (n (%))	Positive TOE examinations (n (%))
Prosthetic valve IE, CIED, CVC associated infection	51 (26)	23 (45)
Suspicion of- or confirmed fungal IE	5 (3)	2 (40)
Gram positive (incl. S. aureus) bacteraemia and clinical suspicion of IE	115 (59)	42 (37)
Suspicion of abscess	2 (1)	2 (100)
Slow therapeutic response and persistent positive blood culture after 72–96 h	18 (9)	9 (50)
Complicated IE	10 (5)	10 (100)
Positive TTE	12 (6)	12 (100)
Inconclusive TTE and clinical suspicion of IE	19 (10)	6 (32)
Negative TTE and clinical suspicion of IE	36 (18)	5 (14)
Total	159 (82)	57 (36)

According to international recommendations [2, 13, 18], TOE should be performed in patients with at least one of the above listed indications
Abbreviations: CIED Cardiovascular implantable electronic device, CVC Central venous catheter, IE Infective endocarditis, n number, TOE Transoesophageal echocardiography, TTE Transthoracic echocardiography

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