Editorial Comment

Infective Endocarditis: A Deadly Disease if Diagnosed Too Late

What Do the Guidelines Say?

Three sets of recommendations have been published in the past 2 years4, 5, 6:

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  An American Heart Association scientific statement on IE in adults was published in 2015.⁶ The role of echocardiography is very well detailed, and the recommendations are the following:

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    TTE should be performed in all cases of suspected IE (Class I, Level of Evidence B).

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    TEE should be done if initial transthoracic images are negative or inadequate in patients in whom there is ongoing suspicion for IE or when there is

Results of the Present Study

In an impressive effort, Sivak et al.,³ in a retrospective analysis, compared two diagnostic approaches, the standard one (no vegetation by TTE) and a new one (strict negative criteria) incorporating the absence of other findings on TTE that suggest increase risk for IE, such as valvular stenosis or sclerosis, intracardiac foreign bodies, and anatomic abnormalities such as ventricular septal defects, pericardial effusion, and structural valvular disease. From a large series of 3,495

Should We Modify the Guidelines?

Although the investigators should be congratulated for their efforts to try to reduce the number of unnecessary transesophageal echocardiographic examinations, their results clearly do not provide sufficient rationale to modify the current guidelines, for the following reasons:

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  The first assertion of the authors (“The guidelines do not account for the quality of initial TTE”) is not true; both the American and European guidelines clearly include the quality of TTE in their indications to perform