All patients with suspected infective endocarditis should undergo TTE.
All patients with Staphylococcus aureus bacteremia should undergo TTE.
The sensitivity of TTE is about 60%, whereas the sensitivity of TEE is about 90%.
A negative TTE does not rule out the diagnosis of infective endocarditis.
Indications for TEE
Consider TEE in patients with suspected complications of infective endocarditis, including heart failure, paravalvular abscess or new AV heart block.
Consider TEE in patients with high-risk echocardiographic features, including large or mobile vegetations, valvular insufficiency, suggestion of perivalvular extension, or secondary ventricular dysfunction.
Consider TEE in patients with prosthetic heart valves, given poor sensitivity of trans-thoracic echocardiogram TTE in these patients.