(P206) THE ADDITIVE VALUE OF REPEATED TRANSTHORACIC ECHOCARDIOGRAPHY WITHIN ONE-WEEK INTERVAL TO RULE OUT INFECTIVE ENDOCARDITIS IN PATIENTS WITH STAPHYLOCOCCUS AUREUS BACTEREMIA

Saturday, October 26, 2024

1:30 PM – 2:00 PM PT

Location: BOARD 63

Presenting Author(s)

RA

Rami M. Abazid, FRCPC (he/him/his)

DR
Sault Area Hospital
Sault Ste Marie, Ontario, Canada

Author(s)

OS

Osama Smettei, MD

DR
FRCPC
London, Ontario, Canada
SD

Sabe De, MD

DR
FRCPC
London, Ontario, Canada
SA

Sameh Awadallah, MD

DR
MD
London, Ontario, Canada
AW

Adel Widyan, md

Phd
MD
Qassim, Al Qasim, Saudi Arabia
AM

Andrew Mathew, MD

MD
FRCPC
London, Ontario, Canada
RB

Rodrigo Bagur, MD

DR
FRCPC
London, Ontario, Canada
NT

Nikolaos Tzemos, MD

DR
FRCPC
LONDON, Ontario, Canada

Supervisor(s)

NT

Nikolaos Tzemos, MD

DR
FRCPC
LONDON, Ontario, Canada

Disclosure(s):

Rami M. Abazid, FRCPC: No financial relationships to disclose

Background: We aim to analyze the additive value of the repeated transthoracic echocardiography (TTE) within one-week interval after the an initial TTE to diagnose infective endocarditis (IE) in patients admitted with staphylococcus aureus bacteremia (SAB).

METHODS AND RESULTS: We prospectively enrolled consecutive patients with SAB who were referred for TTE and transesophageal echocardiography (TEE) to rule out IE between January 2017 to December 2019. All patients underwent a second TTE within 5-7 days after the initial TTE. We excluded patients with previous IE, valve repair/replacement, patients with cardiac devices or with dialysis catheter in place.

Results: A total of 105 patients were enrolled, with a mean age of 52  4 years. Women were 40 (38.1%). There were 64 (53.3%) patients with a defined source of infection, and 36 (34.3%) were intravenous drug users. The majority, 74 (70.5%) had methicillin-sensitive SA. There were 16 (15.2%) patients diagnosed with IE, including eight tricuspid valve IE, four mitral valve IE, three aortic valve IE, and one patient with double valve IE (mitral and tricuspid). The total deaths was 8 (7.6%), two with IE and six without IE. In comparison to TEE, only one patient with vegetation was missed on the first TTE, while it was detected on the second TTE. The baseline TTE identified echocardiographic evidence of IE with a sensitivity of 93.4%, a specificity of 87.6% and an accuracy of 88.6%; while, the second TTE, had a sensitivity of 100%, a specificity of 95.5%, and a diagnostic accuracy of 96.2% in the detection of IE.

Conclusion: Repeating TTE within 5-7 days of an initial TTE has a very high additive diagnostic value in identifying any evidence of IE among patients with SAB. Normal baseline and repeated TTEs yield a high negative predictive value of 100% for excluding IE, suggesting the potential to replace TEE in this context.