Implementation of Cardiac Computed Tomography for Aortic Valve Infective Endocarditis: Coronary Arteries Evaluation and Concordance with Transoesophageal Findings

Background: Cardiac computed tomography (CCT) is recommended as a complementary exam and for coronary artery disease evaluation in patients with aortic valve IE (AVIE). We aimed to evaluate the performance of CCT in visualizing coronary arteries in patients with AVIE and its concordance with transoesophageal findings. Methods: We included patients admitted for AVIE who underwent CCT from 2016 to 2023. Coronary arteries were divided into 17 segments according to the American Heart Association and compared using generalized linear models extended to the binomial family. Results were presented as risk differences (RDs) and 95% confidence intervals (CIs). For those undergoing cardiac surgery, we evaluated the concordance among CCT, TOE, and surgical inspection using Cohen’s kappa (κ) test. Results: During the study period, 39 patients with AVIE performed CCT, of whom 28 underwent cardiac surgery. Visibility of coronary arteries was lower in median segments (RD −0.23; 95% CI −0.32 to −0.14) and in distal segments (RD −0.25; 95% CI −0.36 to −0.15) compared to proximal ones. Visibility of left anterior descending artery 2 was higher compared to right coronary artery 2 (RD 0.33; 95% CI 0.07 to 0.45) and obtuse marginal (RD 0.33; 95% CI 0.52 to 0.15). Concordance between CCT and TOE was globally low for vegetations (kappa 0.14), pseudoaneurysms (kappa 0.46), and paravalvular leakage (kappa 0.36). Conclusions: This study highlights the complementary role of CCT in diagnosing IE, given its low concordance with TOE for specific IE lesions. Furthermore, while CCT offers good visibility of the proximal coronary arteries in patients with AVIE, the visibility of the median and distal segments may be suboptimal.