Abstract 18375: Role of Preoperative Cardiac CT in the Evaluation of Infective Endocarditis: Comparison With Transesophageal Echocardiography and Surgical Findings
Introduction: Cardiac CT is increasingly used for planning cardiothoracic surgeries; however, the utility and accuracy of this modality in depicting the features and complications of infective endocarditis (IE) have not previously been analyzed
Hypothesis: We sought to assess the sensitivity and specificity of cardiac CT vs trans esophageal echocardiography (TEE) and direct surgical findings in patients with IE.
Methods: CT findings, including evidence of pseudoaneurysm, abscess, vegetation, and dehiscence, were compared with TEE findings and pathological reports (gold standard). Among 899 patients with surgically proven IE, 122 underwent contrast-enhanced ECG-gated cardiac CT imaging were included in the study; 84 of these patients also underwent TEE.
Results: Overall, there was no significant difference between CT and TEE in the identification of pseudoaneurysm/abscess and dehiscence (Figiur-1). For the detection of pseudoaneurysm/abscess in prosthetic valves, CT demonstrated higher sensitivity (81% vs 64%) and specificity (75% vs 33%) in patients with mechanical aortic valves; TEE demonstrated marginally higher sensitivity (72% vs 63%) and specificity (80% vs 73%) in patients with bioprosthetic aortic valves. TEE demonstrated significantly higher sensitivity (85% vs 16%) in identifying vegetation in all patients (P < 0.0001), including patients with prosthetic valves (sensitivity, 78% vs 19%). The combined imaging findings of CT and TEE demonstrated improved sensitivity in identifying pseudoaneurysm/abscess and slightly improved detection of prosthesis dehiscence.
Conclusions: Preoperative cardiac CT can be seen as complementary to TEE in assessing complications of suspected IE or may be substituted for TEE when vegetation or dehiscence is depicted on transthoracic echocardiography and the patient has a contraindication to TEE.
Author Disclosures: S. Koneru: None. O. Jorge: None. S.T. Hussain: None. Z. Popovic: None. L.L. Rodriguez: None. N. Shrestha: None. S. Gordon: None. G. Pattersson: None. M.A. Bolen: None.
- © 2016 by American Heart Association, Inc.