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

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 echoc...

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Autores principales: Petkovic, Ana, Menkovic, Nemanja, Petrovic, Olga, Bilbija, Ilija, Radovanovic, Nikola N., Stanisavljevic, Dejana, Putnik, Svetozar, Maksimovic, Ruzica, Ivanovic, Branislava
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10488865/
https://www.ncbi.nlm.nih.gov/pubmed/37685577
http://dx.doi.org/10.3390/jcm12175482
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author Petkovic, Ana
Menkovic, Nemanja
Petrovic, Olga
Bilbija, Ilija
Radovanovic, Nikola N.
Stanisavljevic, Dejana
Putnik, Svetozar
Maksimovic, Ruzica
Ivanovic, Branislava
author_facet Petkovic, Ana
Menkovic, Nemanja
Petrovic, Olga
Bilbija, Ilija
Radovanovic, Nikola N.
Stanisavljevic, Dejana
Putnik, Svetozar
Maksimovic, Ruzica
Ivanovic, Branislava
author_sort Petkovic, Ana
collection PubMed
description 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.
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spelling pubmed-104888652023-09-09 The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis Petkovic, Ana Menkovic, Nemanja Petrovic, Olga Bilbija, Ilija Radovanovic, Nikola N. Stanisavljevic, Dejana Putnik, Svetozar Maksimovic, Ruzica Ivanovic, Branislava J Clin Med Article 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. MDPI 2023-08-25 /pmc/articles/PMC10488865/ /pubmed/37685577 http://dx.doi.org/10.3390/jcm12175482 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Petkovic, Ana
Menkovic, Nemanja
Petrovic, Olga
Bilbija, Ilija
Radovanovic, Nikola N.
Stanisavljevic, Dejana
Putnik, Svetozar
Maksimovic, Ruzica
Ivanovic, Branislava
The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis
title The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis
title_full The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis
title_fullStr The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis
title_full_unstemmed The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis
title_short The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis
title_sort role of echocardiography and cardiac computed tomography in diagnosis of infective endocarditis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10488865/
https://www.ncbi.nlm.nih.gov/pubmed/37685577
http://dx.doi.org/10.3390/jcm12175482
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