What is the role of echocardiography in patients suspected of having IE?
Echocardiography should be performed expeditiously in patients suspected of having IE. It is a major criterion in the Modified Duke Criteria for the Diagnosis of IE, and can provide evidence of endocardial involvement such as an oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation; abscess; or new partial dehiscence of prosthetic valve or new valvular regurgitation (worsening or changing or pre-existing murmur not sufficient). It is recommended that a transesophageal echocardiography (TEE) be used for patients with prosthetic valves, rated at least possible IE by clinical criteria, or complicated IE (paravalvular abscess), whereas a transthoracic echocardiography (TTE) may be used as the first test in other patients. 