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ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis

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Abstract

Objectives

The aim of this prospective study was to investigate the agreement in findings between ECG-gated CT and transoesophageal echocardiography (TEE) in patients with aortic prosthetic valve endocarditis (PVE).

Methods

Twenty-seven consecutive patients with PVE underwent 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared with surgical findings (surgery was performed in 16 patients).

Results

TEE suggested the presence of PVE in all patients [thickened aortic wall (n = 17), vegetation (n = 13), abscess (n = 16), valvular dehiscence (n = 10)]. ECG-gated CT was positive in 25 patients (93 %) [thickened aortic wall (n = 19), vegetation (n = 7), abscess (n = 18), valvular dehiscence (n = 7)]. The strength of agreement [kappa (95 % CI)] between ECG-gated CT and TEE was very good for thickened wall [0.83 (0.62–1.0)], good for abscess [0.68 (0.40–0.97)] and dehiscence [0.75 (0.48–1.0)], and moderate for vegetation [0.55 (0.26–0.88)]. The agreement was good between surgical findings (abscess, vegetation and dehiscence) and imaging for ECG-gated CT [0.66 (0.49–0.87)] and TEE [0.79 (0.62–0.96)] and very good for the combination of ECG-gated CT and TEE [0.88 (0.74–1.0)].

Conclusion

Our results indicate that ECG-gated CT has comparable diagnostic performance to TEE and may be a valuable complement in the preoperative evaluation of patients with aortic PVE.

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Abbreviations

CM:

contrast medium

ECG:

electrocardiogram

PVE:

prosthetic valve endocarditis

TEE:

transoesophageal echocardiography

References

  1. Habib G, Hoen B, Tornos P et al (2009) Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 30:2369–2413

    Article  PubMed  Google Scholar 

  2. Perrotta S, Aljassim O, Jeppsson A, Bech-Hanssen O, Svensson G (2010) Survival and quality of life after aortic root replacement with homografts in acute endocarditis. Ann Thorac Surg 90:1862–1867

    Article  PubMed  Google Scholar 

  3. Wang A, Athan E, Pappas PA et al (2007) Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 297:1354–1361

    Article  PubMed  CAS  Google Scholar 

  4. Habib G, Thuny F, Avierinos JF (2008) Prosthetic valve endocarditis: current approach and therapeutic options. Prog Cardiovasc Dis 50:274–281

    Article  PubMed  Google Scholar 

  5. Chan KL (2002) Early clinical course and long-term outcome of patients with infective endocarditis complicated by perivalvular abscess. CMAJ 167:19–24

    PubMed  Google Scholar 

  6. Zoghbi WA, Chambers JB, Dumesnil JG et al (2009) Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves. J Am Soc Echocardiogr 22:975–1014, quiz 1082–1014

    Article  PubMed  Google Scholar 

  7. Birmingham GD, Rahko PS, Ballantyne F 3rd (1992) Improved detection of infective endocarditis with transesophageal echocardiography. Am Heart J 123:774–781

    Article  PubMed  CAS  Google Scholar 

  8. Daniel WG, Mugge A, Grote J et al (1993) Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions. Am J Cardiol 71:210–215

    Article  PubMed  CAS  Google Scholar 

  9. Daniel WG, Mugge A, Martin RP et al (1991) Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med 324:795–800

    Article  PubMed  CAS  Google Scholar 

  10. Koos R, Mahnken AH, Sinha AM, Wildberger JE, Hoffmann R, Kuhl HP (2004) Aortic valve calcification as a marker for aortic stenosis severity: assessment on 16-MDCT. AJR Am J Roentgenol 183:1813–1818

    PubMed  Google Scholar 

  11. Stein PD, Yaekoub AY, Matta F, Sostman HD (2008) 64-slice CT for diagnosis of coronary artery disease: a systematic review. Am J Med 121:715–725

    Article  PubMed  Google Scholar 

  12. Sun Z, Lin C, Davidson R, Dong C, Liao Y (2008) Diagnostic value of 64-slice CT angiography in coronary artery disease: a systematic review. Eur J Radiol 67:78–84

    Article  PubMed  Google Scholar 

  13. Gilkeson RC, Markowitz AH (2007) Multislice CT evaluation of coronary artery bypass graft patients. J Thorac Imaging 22:56–62

    Article  PubMed  Google Scholar 

  14. Feuchtner GM, Stolzmann P, Dichtl W et al (2009) Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol 53:436–444

    Article  PubMed  Google Scholar 

  15. Li JS, Sexton DJ, Mick N et al (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638

    Article  PubMed  CAS  Google Scholar 

  16. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation 116:1290–1305

    Article  PubMed  Google Scholar 

  17. Gahide G, Bommart S, Demaria R et al (2010) Preoperative evaluation in aortic endocarditis: findings on cardiac CT. AJR Am J Roentgenol 194:574–578

    Article  PubMed  Google Scholar 

  18. Hill EE, Herijgers P, Claus P, Vanderschueren S, Peetermans WE, Herregods MC (2007) Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study. Am Heart J 154:923–928

    Article  PubMed  Google Scholar 

  19. Yeter E, Bayram NA, Akcay M, Keles T, Durmaz T (2009) Aortic valve endocarditis with aortic wall thickening requires close follow-up for a possible abscess formation. Perfusion 24:33–35

    Article  PubMed  CAS  Google Scholar 

  20. Walther T, Autschbach R, Falk V et al (1996) The stentless Toronto SPV bioprosthesis for aortic valve replacement. Cardiovasc Surg 4:536–542

    Article  PubMed  CAS  Google Scholar 

  21. Afridi I, Apostolidou MA, Saad RM, Zoghbi WA (1995) Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: dynamic characterization using transesophageal echocardiographic and Doppler techniques. J Am Coll Cardiol 25:137–145

    Article  PubMed  CAS  Google Scholar 

  22. Tsai IC, Lin YK, Chang Y et al (2009) Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol 19:857–867

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Sahlgrenska University Hospital, Bruna stråket 11b, 41345, Gothenburg, Sweden

    Erika Fagman, Agneta Flinck & Carl Lamm

  2. Department of Cardiovascular Surgery and Anaesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden

    Sossio Perrotta & Gunnar Svensson

  3. Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Odd Bech-Hanssen

  4. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Odd Bech-Hanssen

  5. Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden

    Lars Olaison

  6. Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

    Gunnar Svensson

Authors
  1. Erika Fagman
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  2. Sossio Perrotta
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  3. Odd Bech-Hanssen
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  4. Agneta Flinck
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  5. Carl Lamm
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  6. Lars Olaison
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  7. Gunnar Svensson
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Corresponding author

Correspondence to Erika Fagman.

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Fagman, E., Perrotta, S., Bech-Hanssen, O. et al. ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis. Eur Radiol 22, 2407–2414 (2012). https://doi.org/10.1007/s00330-012-2491-5

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  • DOI: https://doi.org/10.1007/s00330-012-2491-5

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