Utility of cardiac computed tomography scanning in the diagnosis and pre-operative evaluation of patients with infective endocarditis

  • Jason R. Sims
  • Nandan S. Anavekar
  • Krishnaswamy Chandrasekaran
  • James M. Steckelberg
  • Walter R. Wilson
  • Bernard J. Gersh
  • Larry M. Baddour
  • Daniel C. DeSimone
Original Paper
  • 21 Downloads

Abstract

Transesophageal echocardiography (TEE) is the gold standard imaging study used in the diagnosis of infective endocarditis (IE). Computed tomography angiography (CTA) has undergone rapid advancement as a cardiac imaging technique and has previously shown promise in small non-randomized studies for evaluation of IE. We hypothesized that cardiac CTA would perform similarly to TEE in the detection of endocarditic lesions and that there would be no difference in clinical outcomes whether the coronary arteries were evaluated by CTA or invasive coronary angiography (ICA). 255 adults who underwent surgery for IE at the Mayo Clinic Rochester between January 1, 2006 and June 1, 2014 were identified retrospectively. 251 patients underwent TEE and 34 patients underwent cardiac CTA. TEE had statistically higher detection of vegetations (95.6 vs. 70.0%, p < 0.0001) and leaflet perforations (81.3 vs. 42.9%, p = 0.02) as compared to cardiac CTA. For detection of abscess/pseudoaneurysm TEE had a similar sensitivity to cardiac CTA (90.5 vs. 78.4%, p = 0.21). There was no significant difference in peri-operative outcomes whether coronary arteries were evaluated by CTA or ICA. The greatest advantage of cardiac CT in the setting of IE is its ability to couple the detection of complex cardiac anatomic abnormalities with coronary artery delineation, serving two important components of the diagnostic evaluation, particularly among patients who will require surgical intervention due to IE complications. Cardiac CTA may be considered as an alternate coronary artery imaging modality in IE patients with low to intermediate risk of disease but meet guideline recommendations for coronary artery imaging.

Keywords

Cardiac CT Infective endocarditis Pre-operative evaluation Valvular heart disease Coronary artery disease 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10554_2018_1318_MOESM1_ESM.tif (1.1 mb)
Supplementary material 1 (TIF 1112 KB). Timeline of major advances in infective endocarditis with the corresponding study and sample size. IE infective endocarditis, TTE transthoracic echocardiography, TEE transesophageal echocardiography, CT computed tomography, PET positron emission tomography

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Jason R. Sims
    • 1
  • Nandan S. Anavekar
    • 2
    • 3
  • Krishnaswamy Chandrasekaran
    • 2
    • 3
  • James M. Steckelberg
    • 4
  • Walter R. Wilson
    • 4
    • 5
  • Bernard J. Gersh
    • 2
  • Larry M. Baddour
    • 2
    • 4
  • Daniel C. DeSimone
    • 4
  1. 1.Department of Internal MedicineMayo ClinicRochesterUSA
  2. 2.Department of Cardiovascular DiseasesMayo ClinicRochesterUSA
  3. 3.Department of RadiologyMayo ClinicRochesterUSA
  4. 4.Division of Infectious DiseasesMayo ClinicRochesterUSA
  5. 5.Department of Orthopedic SurgeryMayo ClinicRochesterUSA

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