Cardiac CT detected vegetation in 72.0% of infective endocarditis patients compared to 97.3% with TEE, though it showed comparable diagnostic performance for large vegetations ≥10 mm.
Observational (n=75)
Does cardiac computed tomography provide comparable diagnostic performance to transesophageal echocardiography for identifying vegetation and intracardiac complications in patients with infective endocarditis?
Cardiac CT is comparable to TEE for detecting large vegetations and perivalvular abscesses in infective endocarditis, but TEE remains superior for detecting small vegetations, valve perforations, and fistulas.
Absolute Event Rate: 72% vs 97.3%
Background— Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE). Methods and Results— Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated ( r =0.593; P <0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism ( r =0.608; P <0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated ( r =0.187; P =0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess. Conclusions— Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.
Kim et al. (Thu,) conducted a observational in Infective endocarditis (n=75). Cardiac computed tomography (CT) with 3-dimensional reconstruction vs. Transesophageal echocardiography (TEE) with 3-dimensional reconstruction was evaluated on Detection rate of vegetation. Cardiac CT detected vegetation in 72.0% of infective endocarditis patients compared to 97.3% with TEE, though it showed comparable diagnostic performance for large vegetations ≥10 mm.