The diagnostic ability of echocardiography for infective endocarditis and its associated complications

Abstract

Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations.

Keywords:

• diagnosis
• echocardiography
• infective endocarditis
• periannular complications
• prognosis
• surgery
• vegetation

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Echocardiography remains a mainstay in the diagnosis of infective endocarditis (IE) and its associated complications.

• Transoesophageal echocardiography (TOE) is recommended in most patients with left-sided IE.

• In right-sided IE, the main echocardiographic modality will depend on the patients’ clinical profile.

• A negative echocardiographic examination does not rule out IE. Repeat transthoracic echocardiography and TOE may be necessary in some situations.

• Echocardiographic criteria show a lower diagnostic accuracy in prosthetic valve and in cardiac implantable electronic devices IE.

• Results of the echocardiographic study must be interpreted according to the clinical scenario.

• 3D TOE should be regarded as a supplement to standard TOE.

• Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease.

Notes

IE: Infective endocarditis; IVDU: Intravenous drug users; TOE: Transoesophageal echocardiography.

CDRIE: Cardiac implantable electronic devices; IVDU: Intravenous drug users; TOE: Transoesophageal echocardiography; TTE: Transthoracic echocardiography.