Because of its greater sensitivity, transesophageal echocardiography (TEE) is often misused as a screening tool for the exclusion of infective endocarditis (IE) in patients with small clinical probability of the disease. This study examined the role of using TEE exclusively at a Canadian tertiary care center for the diagnosis of IE and determined which clinical variables are most often associated with positive or negative echocardiographic results supporting or refuting the diagnosis.