Multimodality Imaging in Infective Endocarditis

Author:

Erba Paola A.12,Pizzi Maria N.34,Roque Albert54,Salaun Erwan6,Lancellotti Patrizio78,Tornos Pilar9,Habib Gilbert610

Affiliation:

1. Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Italy (P.A.E.).

2. University of Groningen, University Medical Center Groningen, Medical Imaging Center, The Netherlands (P.A.E.).

3. Departments of Cardiology (M.N.P.), Hospital Universitari Vall d’Hebron, Barcelona, Spain.

4. Universitat Autònoma de Barcelona, Spain (M.N.P., A.R., P.T.).

5. Radiology (A.R.), Hospital Universitari Vall d’Hebron, Barcelona, Spain.

6. APHM, La Timone Hospital, Cardiology Department, Marseille, France (E.S., G.H.).

7. Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Belgium (P.L.).

8. Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy (P.L.).

9. Department of Cardiology, Hospital Quirónsalud, Barcelona, Spain (P.T.).

10. Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, France (G.H.).

Abstract

Infective endocarditis (IE) is a complex disease with cardiac involvement and multiorgan complications. Its prognosis depends on prompt diagnosis that leads to an aggressive therapeutic management combining antibiotic therapy and early cardiac surgery when indicated. However, IE diagnosis always poses a challenge, and echocardiography remains diagnostically imperfect in cases of prosthetic valve IE or cardiac implantable electronic device infection. In recent years, other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) have experienced significant technical improvements, and their application to the detection of cardiac and extracardiac IE-related lesions seems to be a strategic way forward in the management of patients with suspected IE. However, the scientific evidence in the literature remains limited; current guidelines address the use of the multimodality imaging in the field of IE with caution; the incremental value of each technique and their combinations is debated; and their use varies across countries. Despite these limitations, healthcare providers and surgeons should be aware of the possibilities offered by the multimodal imaging approach when appropriate. Here, we emphasize the value of a multidisciplinary heart valve team, the endocarditis team, underlining the importance of cardiac and extracardiac imaging experts in playing a key role in informing the diagnosis and management of patients with IE. Illustrative cases, critical appraisal of contemporary data, and conceptual and practical suggestions for clinicians that may help to improve the prognosis of patients with IE are provided in this review article.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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