Echocardiography in Infective Endocarditis: An Update on its Usefulness: How, When, How Much and Where?

Echocardiography is the main imaging technique in the diagnosis of Infective Endocarditis (IE). In 85-90% of cases this diagnosis is based on some echocardiographic criteria. Transthoracic echocardiography is an inexpensive test, quickly accessible without side effects, which has become the initial imaging technique of choice in the diagnosis of IE, as well as in the assessment of complications and follow-up. Transesophageal echocardiography also plays an important role in IE, increasing the diagnostic accuracy to almost 90%, especially in complicated cases. The new technologies implemented in the last decade have improved the assessment of these patients. Among them, 3D echocardiography has proven to be useful in the localization of periprosthetic leaks, valve perforations, fistulae as well as in the extensions of aneurysms and abscesses. The increased availability of echographs and the reduction in their size have led to perform hand-held cardiac ultrasound not only by cardiologists, but also by intesivists, anesthesiologists and internists among other specialties. This review is intended to help the clinician to better understand the usefulness of echocardiographic technique in the IE assessment and to review its new roles with the evolution of technology.