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Clin Infect Dis. 2019 Jan 7. doi: 10.1093/cid/ciz014. [Epub ahead of print]

Risk-benefit assessment of systematic thoracoabdominopelvic CT scan in infective endocarditis.

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Department of Infectious Disease, CHU Hôtel-Dieu, Nantes, France.
CIC UIC 1413 INSERM, CHU Nantes, France.
Intensive Care and Infectious Disease Unit, Groupe Saint-André, CHU Bordeaux, Bordeaux, France.
Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France.
Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France.
Anaesthesiology, University Hospital, Nantes, France.



In the management of Infective Endocarditis (IE), the presence of extracardiac complications has an influence on both diagnosis and treatment. Current guidelines suggest that systematic thoraco-abdomino-pelvic CT scan (TAP-CT) may be helpful. Our objective was to describe how systematic TAP-CT affects the diagnosis and the management of IE.


In this multicenter cohort study, between January 2013 and July 2016 we included consecutive patients who had definite or possible IE according to the Duke-modified criteria, validated by endocarditis teams. We analyzed whether the Duke classification and the therapeutic management were modified regarding the presence or the absence of IE-related lesion on the CT and investigated the tolerance of this exam.


Of the 522 patients included in this study, 217 (41.6%) had one or more IE-related lesion. On the basis of CT results in asymptomatic patients, diagnostic classification was upgraded from possible endocarditis to definite endocarditis for only 4 cases (0.8%). The presence of IE-related lesion on CT did not modify the duration of antibiotic treatment (p=0.55), nor the decision of surgical treatment (p=0.39). Specific treatment of the lesion was necessary in 42 patients (8.0%) but only 9 of these lesions (1.9%) were asymptomatic and diagnosed only on the TAP-CT. Acute kidney injury (AKI) within 5 days of the CT was observed in 78 patients (14.9%).


The TAP-CT findings slightly affected diagnosis and treatment of IE in a very small proportion of asymptomatic patients. Furthermore, contrast media should be used with caution because of the high risk of AKI.


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