Two-dimensional and three-dimensional transesophageal echocardiography in the diagnosis of infective endocarditis of native and prosthetic valves

Purpose. The purpose of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3D-TEE) compared to two-dimensional transesophageal echocardiography (2D-TEE) in the diagnosis of infective endocarditis (IE) of native and prosthetic valves. Methods. Forty-three patients with clinically suspected IE were studied. The patients had clinical, microbiological and echocardiographic assessment to establish a diagnosis of IE in accordance to current guidelines recommendations. Presence, location and size of vegetations, new or progressive valve regurgitation, possible chordae tendineae rupture, paravalvular extension, and new dehiscence of a valve prosthesis were assessed by echocardiography. Results. In 25 (58%) patients the diagnosis of IE was established. Thirteen patients had native valves and 12 patients had prosthetic valves (9 mechanical, 3 biological). 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 91% and 89%, 88% and 91%, 84% and 86%, and 93% and 90%, respectively, in native valves, and of 92 and 90% 91% and 97% (p=0.002), 84% and 82% and 89% and 95% (p=0.01), respectively, in patients with prosthetic valves. Major vegetation diameter was 18mm for 3D-TEE and 16mm for 2D-TEE in native valves and 19mm for 3D-TEE and 14mm for 2D-TEE in prosthetic valves (p=0.04). Peri-annular extension was detected by any of the echocardiographic modalities in three patients with native valve IE and two patients with prosthetic valves, and by 3D-TEE only and not by 2D-TEE in one patient with prosthetic valve. Conclusions. Patients with prosthetic valve infective endocarditis seem to have more additive benefit from 3D-TEE compared to patients with native valve IE.