An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis-the timing and mode of assessment (TTE or TEE).

In general, the recommendations proposed in the 9 identified guidelines on the appropriate use of echo are satisfying. The guideline quality score can be taken into account by the clinicians when evaluating the recommendations for clinical decisions. Additional studies with high evidence level should be conducted on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE.