“Use of the Valve Visualization on Echocardiography Grade Tool Improves Sensitivity and Negative Predictive Value of Transthoracic Echocardiogram for Exclusion of Native Valvular Vegetation”
CME Information: 1 credit
Release date: December 2019 Valid through: December 2020
Introduction/Statement of Need:
Transesophageal echocardiography (TEE) remains the preferred test to rule out infective endo-carditis (IE) but is resource intensive and carries risk. Multiple studies report low sensitivity of transthoracic echocardiography (TTE) for detection of IE; however, these studies did not account for TTE quality. We test the validity of a simple valve visualization grading tool to stratify TTEs by quality and determine whether a high-quality TTE may be used to exclude valvular vegetation and forgo the need for TEE.
This activity is designed for all cardiac sonographers and cardiovascular physicians with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals.
At the end of this article the reader will better be able to:
Recognize a novel scoring tool for evaluating patients with suspected infective endocarditis
Develop a skill set for evaluating leaflet visualization and leaflet clarity for the assessment of vegetations
Create an algorithm for the use of TEE (transesophageal echocardiography) following a VEG score TTE (transthoracic echocardiography)
Acknowledge the role of clinical judgment relative to the application of a VEG score when defining necessary diagnostic testing
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Katherine Connolly, MD, Geraldine Ong, MD, MSc, Michael Kuhlmann, MD, Edwin Ho, MD, Kevin Levitt, MD, MSc, Husam Abdel-Qadir, MD, PhD, Jeremy Edwards, MD, Chi-Ming Chow, MD, MSc, Mohammed-Salah Annabi, MD, MSc, Ezequiel Guzzetti, MD, Erwan Salaun, MD, Philippe Pibarot, DVM, PhD, Idan Roifman, MD, PhD, Howard Leong-Poi, MD, and Kim A. Connelly, MBBS, PhD, Toronto, Ontario and Quebec City, Quebec, Canada
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The following authors reported no actual or potential conflicts of interest in relation to this document:
Katherine Connolly, MD, Geraldine Ong, MD, MSc, Michael Kuhlmann, MD, Edwin Ho, MD, Kevin Levitt, MD, MSc, Husam Abdel-Qadir, MD, PhD, Jeremy Edwards, MD, Chi-Ming Chow, MD, MSc, Mohammed-Salah Annabi, MD, MSc, Ezequiel Guzzetti, MD, Erwan Salaun, MD, Philippe Pibarot, DVM, PhD,Idan Roifman, MD, PhD, Howard Leong-Poi, MD, and Kim A. Connelly, MBBS, PhD, Toronto, Ontario and Quebec City, Quebec, Canada
The following authors reported relationships with one or more commercial interests:
The following CME reviewers, ASE Staff and JASE editors reported no actual or potential conflicts of interest in relation to this document: Carolyn Taylor, MD, FASE, Jin Kyung Kim, MD, PhD, FASE, Elizabeth Lane, and Christina LaFuria
The following CME reviewers, ASE Staff and JASE editors reported relationships with one or more commercial interests:
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et al. 2015 ESC guidelines for the management of infective endocarditis:
the Task Force for the Management of Infective Endocarditis of the European
Society of Cardiology (ESC). Endorsed by: European Association for
Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear
Medicine (EANM). Eur Heart J 2015;36:3075-128.
13. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al.
Recommendations for cardiac chamber quantification by echocardiography
in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14. 14. Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013;26:921-64. 15. Picard MH, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD, et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr 2011; 24:1-10. 16. Cole GD, Dhutia NM, Shun-Shin MJ, Willson K, Harrison J, Raphael CE, et al. Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation. Int J Cardiovasc Imaging 2015;31:1303-14.
17. Canty DJ, Heiberg J, Tan JA, Yang Y, Royse AG, Royse CF, et al. Assessment of image quality of Repeated limited transthoracic echocardiography after cardiac surgery. J Cardiothorac Vasc Anesth 2017;31:965-72. 18. Bai AD, Steinberg M, Showler A, Burry L, Bhatia RS, Tomlinson GA, et al. Diagnostic accuracy of transthoracic echocardiography for infective endocarditis findings using transesophageal echocardiography as the reference standard: a meta-analysis. J Am Soc Echocardiogr 2017;30:639-46.e8. 19. Casella F, Rana B, Casazza G, Bhan A, Kapetanakis S, Omigie J, et al. The potential impact of contemporary transthoracic echocardiography on the management of patients with native valve endocarditis: a comparison with transesophageal echocardiography. Echocardiography 2009;26:900-6. 20. Sivak JA, Vora AN, Navar AM, Schulte PJ, Crowley AL, Kisslo J, et al. An approach to improve the negative predictive value and clinical utility of transthoracic echocardiography in suspected native valve infective endocarditis. J Am Soc Echocardiogr 2016;29:315-22.