These studies concluded that TTE has a lower yield in patients with low probability of endocarditis. TEE is the procedure of choice for patients with intermediate or high probability of endocarditis. Although TEE has been shown to have significantly higher sensitivity than TTE for identifying vegetations [40], specificities were similar at 91% to 100% for TEE and 91% to 98% for TTE. In right-sided endocarditis, TTE and TEE performed comparably, demonstrating similar numbers of vegetations and frequency of tricuspid regurgitation [1,44]. The size and other characteristics of vegetations on echocardiography have been shown to be useful in predicting complications such as peripheral embolization [50]. In left-sided native valve S. aureus endocarditis, the presence of an intracardiac abscess and left ventricular ejection fraction <40% on echocardiography has been shown to be independent predictors of in-hospital mortality [45]. In this same group of patients, intracardiac abscess and valve perforation on echocardiography have been shown to be independent predictors of 1-year mortality [45]. Variant 2: Known or suspected infective endocarditis. Additional imaging to direct patient management or treatment. Arteriography Coronary The primary role of catheterization is for the presurgical evaluation of the coronary arteries [7,12]. It may be used to assess the severity of valvular dysfunction and ventricular function, but this use has largely been replaced by echocardiography [12]. CT Chest The primary role of CT chest is in evaluating complications of infective endocarditis after a diagnosis has been made. Routine CT chest can be helpful in right-sided endocarditis for demonstrating septic pulmonary infarcts and abscesses, osteomyelitis, and for preoperative assessment and surgical planning [25]. CT Heart Function and Morphology The primary role of CT heart is in evaluating complications of infective endocarditis such as paravalvular and myocardial abscesses and pseudoaneurysms [15-20,51].
Infective Endocarditis. These studies concluded that TTE has a lower yield in patients with low probability of endocarditis. TEE is the procedure of choice for patients with intermediate or high probability of endocarditis. Although TEE has been shown to have significantly higher sensitivity than TTE for identifying vegetations [40], specificities were similar at 91% to 100% for TEE and 91% to 98% for TTE. In right-sided endocarditis, TTE and TEE performed comparably, demonstrating similar numbers of vegetations and frequency of tricuspid regurgitation [1,44]. The size and other characteristics of vegetations on echocardiography have been shown to be useful in predicting complications such as peripheral embolization [50]. In left-sided native valve S. aureus endocarditis, the presence of an intracardiac abscess and left ventricular ejection fraction <40% on echocardiography has been shown to be independent predictors of in-hospital mortality [45]. In this same group of patients, intracardiac abscess and valve perforation on echocardiography have been shown to be independent predictors of 1-year mortality [45]. Variant 2: Known or suspected infective endocarditis. Additional imaging to direct patient management or treatment. Arteriography Coronary The primary role of catheterization is for the presurgical evaluation of the coronary arteries [7,12]. It may be used to assess the severity of valvular dysfunction and ventricular function, but this use has largely been replaced by echocardiography [12]. CT Chest The primary role of CT chest is in evaluating complications of infective endocarditis after a diagnosis has been made. Routine CT chest can be helpful in right-sided endocarditis for demonstrating septic pulmonary infarcts and abscesses, osteomyelitis, and for preoperative assessment and surgical planning [25]. CT Heart Function and Morphology The primary role of CT heart is in evaluating complications of infective endocarditis such as paravalvular and myocardial abscesses and pseudoaneurysms [15-20,51].