Arteriography Coronary There is limited evidence in the literature for the use of catheterization for assessing patients with suspected infective endocarditis. The primary indication is for presurgical evaluation of the coronary arteries [12]. CT Chest There is limited evidence in the literature for the use of CT chest to assess patients with suspected infective endocarditis. The primary role of CT chest is in evaluating pulmonary complications of infective endocarditis and can be particularly helpful in right-sided endocarditis for demonstrating septic pulmonary infarcts and abscesses [13,14]. CT Heart Function and Morphology CT is less accurate than TTE and transesophageal echocardiography (TEE) for identifying valvular vegetation. Consequently, the primary role of CT is in evaluating complications of infective endocarditis such as paravalvular and myocardial abscesses and pseudoaneurysms [15-20]. In depicting aortic valve pseudoaneurysms, one study showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 87.5%, 91.7%, and 100%, respectively [18]. The primary weakness of CT is in detecting native aortic valve vegetations <1 cm in size for which the NPV was 55.5%. However, the sensitivity, specificity, PPV, and NPV were all 100% for vegetations >1 cm in size [18]. One study also showed CT to lack sensitivity for detecting valve perforations when compared with TEE [17]. Compared with echocardiography, CT may be superior in both detecting and visualizing the full extent of a paravalvular abscess, pseudoaneurysm, or fistula, particularly in patients with prosthetic valves [7,10,20-23]. CT may be equivalent or superior to echocardiography in identifying vegetations and valve dehiscence in suspected prosthetic valve endocarditis [7,22,24]. CT may also be utilized to assess for abnormalities in the mobility of mechanical heart valves [24].
Infective Endocarditis. Arteriography Coronary There is limited evidence in the literature for the use of catheterization for assessing patients with suspected infective endocarditis. The primary indication is for presurgical evaluation of the coronary arteries [12]. CT Chest There is limited evidence in the literature for the use of CT chest to assess patients with suspected infective endocarditis. The primary role of CT chest is in evaluating pulmonary complications of infective endocarditis and can be particularly helpful in right-sided endocarditis for demonstrating septic pulmonary infarcts and abscesses [13,14]. CT Heart Function and Morphology CT is less accurate than TTE and transesophageal echocardiography (TEE) for identifying valvular vegetation. Consequently, the primary role of CT is in evaluating complications of infective endocarditis such as paravalvular and myocardial abscesses and pseudoaneurysms [15-20]. In depicting aortic valve pseudoaneurysms, one study showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 87.5%, 91.7%, and 100%, respectively [18]. The primary weakness of CT is in detecting native aortic valve vegetations <1 cm in size for which the NPV was 55.5%. However, the sensitivity, specificity, PPV, and NPV were all 100% for vegetations >1 cm in size [18]. One study also showed CT to lack sensitivity for detecting valve perforations when compared with TEE [17]. Compared with echocardiography, CT may be superior in both detecting and visualizing the full extent of a paravalvular abscess, pseudoaneurysm, or fistula, particularly in patients with prosthetic valves [7,10,20-23]. CT may be equivalent or superior to echocardiography in identifying vegetations and valve dehiscence in suspected prosthetic valve endocarditis [7,22,24]. CT may also be utilized to assess for abnormalities in the mobility of mechanical heart valves [24].