Comprehensive CT study to assess local and systemic involvement in patients with infective endocarditis: experience from a multidisciplinary team of a tertiary referral center.

Abstract

Purpose: To evaluate the value of a computed tomography (CT) protocol, including ECG-gated cardiac angiographic and venous phase, in patients with infective endocarditis (IE).

Material and methods: From January 2019 to October 2022, consecutive patients with IE submitted to total-body CT, including ECG-gated cardiac acquisition in angiographic and venous phase, were enrolled. Transesophageal echocardiography was performed in all cases. Rate of local complications including vegetation, pseudoaneurysm, abscess, fistula and valve dehiscence was compared in CT and echocardiography. Systemic embolization was identified through CT scans.

Results: Seventy-six adults (median age 69 [IQR 55-77] years old; males 54/76, 71%] were enrolled. Most patients underwent surgery (51/76, 67%), and the in-hospital mortality rate was 8% (6/76). CT showed higher detection rate of valve vegetation compared to echocardiography (67/76, 88% vs 58/76, 76%; p = 0.008), including vegetation smaller than 10 mm (24/76, 36% vs 16/76, 28%; p = 0.013) and higher detection rate of pseudoaneurysm and abscess (p = 0.004 and p = 0.009, respectively). Abscess showed higher contrast-to-noise ratio (CNR) in the venous scan compared to angiographic scan (2.75 [IQR 2.27; 5.17] vs 1.97 [IQR 1.21; 3.32], p = 0.039) and higher density of perivalvular and epicardial fat compared to pseudoaneurysm (35 [IQR 31; 52]HU and - 50 [IQR - 62; - 35]HU versus 52 [IQR - 60; - 18]HU; p = 0.001, and - 91 [IQR - 95; - 81]HU; p = 0.007, respectively), for greater inflammation. CT overestimated valve dehiscence when compared to echocardiography and surgery.

Conclusion: A comprehensive CT study enhances the diagnostic assessment of patients with IE, not only by detecting distant sites of embolization, but also increasing sensitivity for valve vegetation and local complications.