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Circ Cardiovasc Imaging. 2018 Mar;11(3):e006986. doi: 10.1161/CIRCIMAGING.117.006986.

Comparison of Cardiac Computed Tomography With Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients With Infective Endocarditis in the Era of 3-Dimensional Images.

Author information

1
From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.).
2
From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.). cysprs@yuhs.ac dryj@yuhs.ac.

Abstract

BACKGROUND:

Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE).

METHODS AND RESULTS:

Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (r=0.593; P<0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism (r=0.608; P<0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated (r=0.187; P=0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess.

CONCLUSIONS:

Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.

KEYWORDS:

echocardiography; endocarditis; humans; imaging, three-dimensional

PMID:
29555833
DOI:
10.1161/CIRCIMAGING.117.006986
[Indexed for MEDLINE]

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