Optimizing Echo Data

The sensitivity of Transthoracic echocardiogram (TTE) is about 60%, whereas Transesophageal echocardiogram (TEE) is ~90%

A negative TTE does not rule out the diagnosis of IE

To assess for anatomy and complications when TTE is positive (especially if large vegetation, valvular insufficiency, or suspected paravalvular extension)

When the pre-test probability of IE is high, or anatomy is unique: Prosthetic valve, congenital heart disease, previous IE, S. aureus bacteremia

Complications of IE suspected: heart failure, paravalvular abscess, new AV block

Poor quality TTE: obstructive lung disease, obesity