The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis

Ana Petkovic; Nemanja Menkovic; Olga Petrovic; Ilija Bilbija; Nikola N Radovanovic; Dejana Stanisavljevic; Svetozar Putnik; Ruzica Maksimovic; Branislava Ivanovic

doi:10.3390/jcm12175482

The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis

J Clin Med. 2023 Aug 25;12(17):5482. doi: 10.3390/jcm12175482.

Authors

Ana Petkovic¹, Nemanja Menkovic¹, Olga Petrovic², Ilija Bilbija³, Nikola N Radovanovic⁴, Dejana Stanisavljevic⁵, Svetozar Putnik³, Ruzica Maksimovic⁶, Branislava Ivanovic²

Affiliations

¹ Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
² Cardiology Clinic, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
³ Department for Cardiac Surgery, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
⁴ Pacemaker Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
⁵ Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
⁶ Center of Radiology, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.

Abstract

Background: Infective endocarditis (IE) is a rare disease with a high mortality rate and rising incidence, requiring timely and precise diagnosis in order to choose appropriate therapy. Imaging of morphologic lesions is an integrative part of diagnosis. Artifacts and the patient's habitus make echocardiography difficult to visualize advanced-form IE. Cardiac computed tomography (CCT) constantly shows an additive diagnostic value due to high resolution of cardiac anatomy. Conjecturally, joint application of both diagnostic tests improves overall sensitivity and specificity in diagnosing IE.

Methods: Patients with definite IE underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and CCT. We analyzed valvular and paravalvular IE lesions in all three imaging methods and compared them to surgical or autopsy findings. We calculated sensitivity, specificity, diagnostic accuracy, and positive and negative predictive value of both imaging tests individually and jointly used.

Results: We examined 78 patients, male to female ratio 2:1, mean age 52.29 ± 16.62. We analyzed 85 valves, 70 native valves, 13 prosthetic valves, and 2 corrected valves due to Ozaki procedure, along with a central shunt and 4 pacemaker leads. As a single test, the sensitivity and specificity of CCT, TTE, and TEE for valvular lesions were 91.6/20%, 65.5/57.9%, and 60/84%, and paravalvular lesions were 100/0%, 46/10.5%, and 14.7/100%. When combined together, sensitivity and specificity for valvular lesions rose to 96.6/0% and paravalvular lesions to 100/0%. We also analyzed the diagnostic performance for each test in single and mutual application, per specific IE lesion.

Conclusion: In the individual application, CCT in comparison to TTE and TEE shows better diagnostic performance in detection of valvular and paravalvular lesions. In joint application, there is a statistically significant difference in performance compared to their single use, especially in prosthetic valves and invasive forms of IE native valves.

Keywords: cardiac computed tomography; infective endocarditis; transesophageal echocardiography; transthoracic echocardiography.

Grants and funding

This research received no external funding.