Utility of Cardiac Computed Tomography Scanning in The Diagnosis and Pre-Operative Evaluation of Patients with Infective Endocarditis

Background: Cardiac computed tomography angiography (CTA) has emerged to become an important cardiac imaging technique. However, its role in assessing cardiac pathologies in infectious endocarditis (IE) syndromes, is still a matter of ongoing investigation.

Aims: We evaluated the diagnostic utility of cardiac CTA in IE vs. TEE for the detection of infectious related pathologies and also vs. invasive coronary angiography (ICA) for the detection of coronary lesions. Surgical inspection served as a reference standard.

Methods and results: Between January 2016 and December 2017 40 patients with clinically suspected IE were examined with TEE and CTA. Surgery was performed in 18 patients (58.7 ± 16.2 years, 66.7% men) with definite IE and an indication for valve replacement. Seven (36.8%) of these patients had prosthetic valve endocarditis. Imaging findings of IE were classified as vegetation, leaflet perforation, abscess and pseudoaneurysm (PA). For detection of abscess/PA, the CTA had better diagnostic accuracy compared to TEE (sensitivity 80% and specificity 100% vs. sensitivity 50% and specificity 100% respectively) and equal diagnostic accuracy for vegetations (sensitivity 84.6% and specificity 71.4% for both). There was no significant difference in peri-operative outcomes whether coronary arteries were evaluated by CTA or ICA.

CONCLUSION: Our ongoing study has demonstrated that CTA is an important adjunct imaging to TEE for detection of IE associated abscess and/or PA. Combined with the ability to reliably exclude CAD, it makes cardiac CTA valuable for accurate diagnosis of IE.