Diagnostic accuracy of transthoracic echocardiography to identify native valve infective endocarditis: a systematic review and meta-analysis

Mattia Bonzi, Giulia Cernuschi, Monica Solbiati, Giuliano Giusti, Nicola Montano, Elisa Ceriani

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Infective endocarditis (IE) is a serious and potentially life-threatening disease, and accurate diagnosis is essential. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of transthoracic echocardiography (TTE), with transesophageal echocardiography (TEE) as the reference standard, in patients with suspected IE of the native valves. We performed a systematic search in MEDLINE, EMBASE and Cochrane Library searching for studies that enrolled adult patients with suspected native valves IE where data about both TTE and TEE could be extracted. We included 11 studies, for a total of 2209 patients. The overall sensitivity, specificity, negative and positive likelihood ratios (LR) of TTE are 0.71 (95% CI 0.56–0.82), 0.80 (95% CI 0.58–0.92), 0.37 (95% CI 0.20–0.68) and 3.56 (95% CI 1.3–9.72), respectively. The subgroup analyses of the studies considering different cut-off levels show that the strict negative criteria (i.e., managing indeterminate results as positive) have the highest sensitivity and the lowest LR−. On the contrary, when managing indeterminate results as negative (standard criteria), the specificity and LR+ are the highest. We observed no differences between the studies performed with older and more recent technologies. In conclusion, our study results support the use of a negative TTE as a single rule-out test in patients with a low pre-test probability. In selected cases, the use of strict negative criteria might exclude IE in intermediate-risk patients, and a positive TTE might be considered as a single rule-in test with no need for TEE if TEE results would not change the patient’s management.

Original languageEnglish
Pages (from-to)937-946
Number of pages10
JournalInternal and Emergency Medicine
Volume13
Issue number6
DOIs
Publication statusPublished - 2018

Fingerprint

Endocarditis
Echocardiography
Meta-Analysis
Transesophageal Echocardiography
MEDLINE
Libraries
Technology
Sensitivity and Specificity

Keywords

  • Diagnostic accuracy
  • Endocarditis
  • Meta-analysis
  • Transesophageal echocardiography
  • Transthoracic echocardiography

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

Cite this

@article{0ffbcfc3d3c04e02a3dee58565afe19e,
title = "Diagnostic accuracy of transthoracic echocardiography to identify native valve infective endocarditis: a systematic review and meta-analysis",
abstract = "Infective endocarditis (IE) is a serious and potentially life-threatening disease, and accurate diagnosis is essential. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of transthoracic echocardiography (TTE), with transesophageal echocardiography (TEE) as the reference standard, in patients with suspected IE of the native valves. We performed a systematic search in MEDLINE, EMBASE and Cochrane Library searching for studies that enrolled adult patients with suspected native valves IE where data about both TTE and TEE could be extracted. We included 11 studies, for a total of 2209 patients. The overall sensitivity, specificity, negative and positive likelihood ratios (LR) of TTE are 0.71 (95{\%} CI 0.56–0.82), 0.80 (95{\%} CI 0.58–0.92), 0.37 (95{\%} CI 0.20–0.68) and 3.56 (95{\%} CI 1.3–9.72), respectively. The subgroup analyses of the studies considering different cut-off levels show that the strict negative criteria (i.e., managing indeterminate results as positive) have the highest sensitivity and the lowest LR−. On the contrary, when managing indeterminate results as negative (standard criteria), the specificity and LR+ are the highest. We observed no differences between the studies performed with older and more recent technologies. In conclusion, our study results support the use of a negative TTE as a single rule-out test in patients with a low pre-test probability. In selected cases, the use of strict negative criteria might exclude IE in intermediate-risk patients, and a positive TTE might be considered as a single rule-in test with no need for TEE if TEE results would not change the patient’s management.",
keywords = "Diagnostic accuracy, Endocarditis, Meta-analysis, Transesophageal echocardiography, Transthoracic echocardiography",
author = "Mattia Bonzi and Giulia Cernuschi and Monica Solbiati and Giuliano Giusti and Nicola Montano and Elisa Ceriani",
year = "2018",
doi = "10.1007/s11739-018-1831-0",
language = "English",
volume = "13",
pages = "937--946",
journal = "Internal and Emergency Medicine",
issn = "1828-0447",
publisher = "Springer-Verlag Italia s.r.l.",
number = "6",

}

TY - JOUR

T1 - Diagnostic accuracy of transthoracic echocardiography to identify native valve infective endocarditis

T2 - a systematic review and meta-analysis

AU - Bonzi, Mattia

AU - Cernuschi, Giulia

AU - Solbiati, Monica

AU - Giusti, Giuliano

AU - Montano, Nicola

AU - Ceriani, Elisa

PY - 2018

Y1 - 2018

N2 - Infective endocarditis (IE) is a serious and potentially life-threatening disease, and accurate diagnosis is essential. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of transthoracic echocardiography (TTE), with transesophageal echocardiography (TEE) as the reference standard, in patients with suspected IE of the native valves. We performed a systematic search in MEDLINE, EMBASE and Cochrane Library searching for studies that enrolled adult patients with suspected native valves IE where data about both TTE and TEE could be extracted. We included 11 studies, for a total of 2209 patients. The overall sensitivity, specificity, negative and positive likelihood ratios (LR) of TTE are 0.71 (95% CI 0.56–0.82), 0.80 (95% CI 0.58–0.92), 0.37 (95% CI 0.20–0.68) and 3.56 (95% CI 1.3–9.72), respectively. The subgroup analyses of the studies considering different cut-off levels show that the strict negative criteria (i.e., managing indeterminate results as positive) have the highest sensitivity and the lowest LR−. On the contrary, when managing indeterminate results as negative (standard criteria), the specificity and LR+ are the highest. We observed no differences between the studies performed with older and more recent technologies. In conclusion, our study results support the use of a negative TTE as a single rule-out test in patients with a low pre-test probability. In selected cases, the use of strict negative criteria might exclude IE in intermediate-risk patients, and a positive TTE might be considered as a single rule-in test with no need for TEE if TEE results would not change the patient’s management.

AB - Infective endocarditis (IE) is a serious and potentially life-threatening disease, and accurate diagnosis is essential. We performed a systematic review and meta-analysis to assess the diagnostic accuracy of transthoracic echocardiography (TTE), with transesophageal echocardiography (TEE) as the reference standard, in patients with suspected IE of the native valves. We performed a systematic search in MEDLINE, EMBASE and Cochrane Library searching for studies that enrolled adult patients with suspected native valves IE where data about both TTE and TEE could be extracted. We included 11 studies, for a total of 2209 patients. The overall sensitivity, specificity, negative and positive likelihood ratios (LR) of TTE are 0.71 (95% CI 0.56–0.82), 0.80 (95% CI 0.58–0.92), 0.37 (95% CI 0.20–0.68) and 3.56 (95% CI 1.3–9.72), respectively. The subgroup analyses of the studies considering different cut-off levels show that the strict negative criteria (i.e., managing indeterminate results as positive) have the highest sensitivity and the lowest LR−. On the contrary, when managing indeterminate results as negative (standard criteria), the specificity and LR+ are the highest. We observed no differences between the studies performed with older and more recent technologies. In conclusion, our study results support the use of a negative TTE as a single rule-out test in patients with a low pre-test probability. In selected cases, the use of strict negative criteria might exclude IE in intermediate-risk patients, and a positive TTE might be considered as a single rule-in test with no need for TEE if TEE results would not change the patient’s management.

KW - Diagnostic accuracy

KW - Endocarditis

KW - Meta-analysis

KW - Transesophageal echocardiography

KW - Transthoracic echocardiography

UR - http://www.scopus.com/inward/record.url?scp=85044024262&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044024262&partnerID=8YFLogxK

U2 - 10.1007/s11739-018-1831-0

DO - 10.1007/s11739-018-1831-0

M3 - Article

AN - SCOPUS:85044024262

VL - 13

SP - 937

EP - 946

JO - Internal and Emergency Medicine

JF - Internal and Emergency Medicine

SN - 1828-0447

IS - 6

ER -