A clinical practice guideline appraisal for appropriate use of echocardiography in adult infective endocarditis—when and by which mode to perform an Echo?
Abstract BackgroundEchocardiography (Echo) is the primary imaging modality of infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) are not fully in agreement among different guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of guidelines. MethodsA search of guidelines containing recommendations for the appropriate use of Echo in IE adult patients published in English between 2007 and 2020 has been conducted. APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument is applied independently by two reviewers to assess the integrated quality of identified guidelines. The recommendations of concern are extracted from related chapters.ResultsA total of 9 guidelines meet the criteria with AGREE II score ranging from 36% to 79%, and the domain of “stakeholder involvement” receives the lowest score. The most contentious issue is, whether a follow-up TEE is mandatory in uncomplicated native valve IE with initial positive TTE. And conflicting recommendations on it are presented with low evidence level for hardly any related evidence based on.ConclusionsIn general, the recommendations proposed in the 9 identified guidelines on the appropriate use of Echo are satisfying. And the guideline quality score could be taken into account by the clinicians when evaluating the recommendations for making clinical decision. More researches are needed in the future, which should be with high evidence level on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE.