Advanced Echocardiography for the Diagnosis and Management of Infective Endocarditis

Abstract

Echocardiography is fundamental for the management of infective endocarditis (IE) across all stages of the illness including diagnosis, surveillance during medical therapy, identification of prognostic markers, planning perioperative intervention, postoperative assessment, and follow-up after completion of definitive therapy. Modern era echocardiography (echo) offers outstanding temporal and spatial image resolution, providing the opportunity for early diagnosis of this life-threatening infection. Emerging imaging modalities, such as real-time three-dimensional (3D) echocardiography, offer a novel way of readily visualizing the extent of intracardiac infection and the relationship of pathology to adjacent cardiac structures, well before surgical intervention, without radiation exposure or significant risk to the patient. Echocardiography can have a positive impact on the management of every stage of this disease, with the opportunity to improve outcomes.

Enterococcus faecalis Endocarditis of All Four Native Valves: A Case Report

“…Notably, TEE has higher sensitivity for detecting vegetation than transthoracic echocardiogram and can detect left-sided lesions as small as 2-5 mm with a sensitivity of 94% to 100% and 77% to 95% of specificity for native and prosthetic valves [9]. However, this is an invasive procedure with high associated costs, and it might not be appropriate for all patients with bacteremia.…”

“…Remarkably, false-positive findings can occur in some scenarios, such as when strands are observed, which is especially important for patients with prosthetic valves [17]. In addition, several other factors could mimic endocarditis, including degenerative valvular tissue, thrombus, flail chords, or artifacts from calcium or prosthetic material [9]. However, clinical signs and symptoms of bacteremia with associated embolization and positive blood cultures should assist physicians in establishing a diagnosis.…”

A case of life-threatening valvulitis mimicking infective endocarditis in systemic juvenile idiopathic arthritis

“…In addition, it may also be found on the upstream side of the mitral and tricuspid valves; outflow tract side of the aortic and pulmonary valves; and along the leaflet coaptation zone. 9 Other echocardiographic findings for the diagnosis of infective endocarditis include abscess or pseudoaneurysm and a new prosthetic cardiac valve dehiscence. 10 Another example of an intracardiac mass is myxoma, which is one of the most common cardiac tumours.…”

Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies

“…This reduced sensitivity of prosthetic valves and intracardiac devices can be explained by imaging challenges, such as artifacts induced by metal components ( Chambers and Bayer, 2020 ; Hubers et al, 2020 ). If TTE is negative and a high level of suspicion for IE persists, then transesophageal echocardiography (TEE) should also be performed ( Sedgwick and Scalia, 2016 ; Sordelli et al, 2019 ; Hubers et al, 2020 ). TEE provides a better characterization of local abnormalities and can detect valvular biofilms as small as 1 mm, whereas biofilms smaller than 5 mm have a reduced TTE sensitivity of 25% ( Erbel et al, 1988 ; Cuervo et al, 2021 ).…”