Multislice Computed Tomography in Infective Endocarditis
Key result
Multislice CT shows ~97% sensitivity for detecting valvular abnormalities in infective endocarditis compared to TEE.
- kappa 0.84
- n=37
Why the study?
The value of multislice computed tomography for assessing valvular abnormalities in infective endocarditis compared with TEE and surgery was not well established.
Does multislice CT accurately detect valvular abnormalities in patients with suspected infective endocarditis compared to TEE and intraoperative findings?
Population
37 consecutive patients with clinically suspected infective endocarditis
Comparison
Multislice CT vs transesophageal echocardiography and intraoperative findings
Design
Observational study with imaging and surgical correlation
Authors
Discussion
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Implication
Multislice CT is highly accurate for detecting valvular vegetations and perivalvular complications in infective endocarditis, offering a valuable adjunct to TEE for preoperative planning.
Key Points
- To evaluate the diagnostic accuracy of multislice computed tomography compared with transesophageal echocardiography and intraoperative findings for detecting valvular abnormalities in patients with suspected infective endocarditis.
- Prospective evaluation of 37 consecutive patients with clinically suspected infective endocarditis who underwent both transesophageal echocardiography and either 64-slice or dual-source computed tomography.
- Twenty-nine patients with confirmed infective endocarditis underwent valve surgery, serving as the anatomical reference standard.
- Compared with transesophageal echocardiography, computed tomography yielded a sensitivity of 97%, specificity of 88%, positive predictive value of 97%, negative predictive value of 88%, and kappa of 0.84 on a per-patient basis (n = 37).
- Against surgical inspection, computed tomography detected vegetations with 96% sensitivity and 97% specificity, identified abscesses or pseudoaneurysms with 100% sensitivity and 100% specificity, and correlated closely with ultrasound for vegetation size (r = 0.95; p < 0.001).
- Computed tomography accurately assessed vegetation mobility in 96% (21/22) of patients and defined perivalvular extension better than echocardiography, though it missed all 4 small leaflet perforations (<= 2 mm).
Study Design
Type
Observational (n=37)
Structured PICO
Does multislice CT accurately detect valvular abnormalities in patients with suspected infective endocarditis compared to TEE and intraoperative findings?
P
Population
37 consecutive patients with clinically suspected infective endocarditis.
E
Exposure
Multislice computed tomography (64-slice CT or dual-source CT)
C
Comparator
Transesophageal echocardiography (TEE) and intraoperative findings (surgery)
O
Outcome
Diagnostic performance (sensitivity, specificity, positive predictive value, and negative predictive value) for the detection of evident valvular abnormalities (vegetations, abscesses/pseudoaneurysms)surrogate
Main Result
Effect estimate: kappa 0.84
Multislice CT is highly accurate for detecting valvular vegetations and perivalvular complications in infective endocarditis, offering a valuable adjunct to TEE for preoperative planning.
Limitations
- Missed all 4 leaflet perforations (≤2 mm)
Cite This Study
Feuchtner et al. (2009) conducted an observational in Infective endocarditis (n=37). Multislice computed tomography (CT) vs. Transesophageal echocardiography (TEE) and intraoperative findings was evaluated on Detection of evident valvular abnormalities for IE compared with TEE on a per-patient basis (kappa 0.84). Multislice CT demonstrated high diagnostic accuracy for detecting evident valvular abnormalities in infective endocarditis, with 97% sensitivity and 88% specificity compared to TEE.