The Role of Echocardiography in the Diagnosis of Infective Endocarditis and its Complications

Infective endocarditis (IE) remains associated with high morbidity and mortality rates despite advances in medical technology, diagnostics, and treatment. Hospital mortality for IE reaches up to 22%, with a five-year mortality rate of 40%. Globally, the incidence of IE has increased, with recent figures indicating 13.8 cases per 100,000 annually, up from 1.5–11.6 per 100,000 reported between 1990 and 2010. A retrospective cohort study in a tertiary care center in Korea demonstrated a significant rise in the monthly incidence of IE from 2.0 in 2005 to 3.8 in 2017. This increase is attributed to the enhanced utilization of diagnostic tools such as echocardiography, computed tomography (CT), and positron emission tomography (PET). The 2015 European Society of Cardiology (ESC) guidelines incorporated complementary imaging modalities like Single Photon Emission Computed Tomography-CT (SPECT/CT), 18F-FDG PET/CT, and Cardiac CT, alongside traditional transthoracic and transesophageal echocardiography. The 2023 ESC guidelines further expanded these algorithms to include Cardiac CTA, MRI, PET/CT, and WBC SPECT. However, transthoracic, and transesophageal echocardiography remain the primary and essential diagnostic tools for suspected IE. This review examines the role of echocardiography in diagnosing IE, highlighting typical ultrasound findings, valve damage, and associated complications. Ultrasound is pivotal for early detection and prognosis of IE, identifying vegetations, abscesses, pseudoaneurysms, and fistulas. New vegetations typically appear irregular and oscillate, with transthoracic echocardiography detecting vegetations larger than 5mm with 90% sensitivity. Detailed echocardiographic assessment provides critical insights for the surgical management of IE and enhances the understanding of IE’s complex pathology.