Sivak et al listed strict criteria for a true negative transesophageal echocardiographic study for exclusion of infective endocarditis involving a native heart valve. The authors are from Duke University.


Patient selection: suspected native valve infective endocarditis


Evaluation: transesophageal echocardiography (TEE)


Native valve infective endocarditis can be excluded if all of the following are present:

(1) There are no vegetations.

(2) The quality of the study is at least moderate.

(3) The valve anatomy is normal (see below).

(4) Valvular regurgitation is less than mild (none or minimal).

(5) If there is a pericardial effusion then it is mild and simple.

(6) There is an absence of central venous catheter and leads (pacemaker, defibrillator).

(7) There is no valvular stenosis or sclerosis.


Normal anatomy:

(1) all 4 valves normal

(2) absence of mitral annular calcifications

(3) absence of mitral valve prolapse

(4) absence of an atrial septal defect (ASD), unrepaired or repaired

(5) absence of ventricular septal defect (VSD), unrepaired or repaired


The negative predictive value was 97% using the strict negative criteria vs 87% when only absence of a vegetation was considered.


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