TY - JOUR
T1 - Diagnostic Potential of Intracardiac Echocardiography in Patients with Suspected Prosthetic Valve Endocarditis
AU - Østergaard, Lauge
AU - Vejlstrup, Niels
AU - Køber, Lars
AU - Fosbøl, Emil Loldrup
AU - Søndergaard, Lars
AU - Ihlemann, Nikolaj
N1 - Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - BACKGROUND: The use of transthoracic and transesophageal echocardiography may be challenging in patients suspected of having prosthetic valve endocarditis (PVE). Intracardiac echocardiography (ICE) provides a new diagnostic tool in the examination of patients with PVE, yet few data on its use have been published.METHODS: From January 2012 to December 2016, patients with suspected PVE and inconclusive findings on transthoracic and transesophageal echocardiography were further examined with ICE. Medical records were reviewed to assess clinical status, microbiologic etiology, echocardiography, antibiotic treatment, and surgical procedures. The modified Duke criteria were used to assess the diagnostic classification after ICE.RESULTS: A total of 38 patients suspected of having PVE were included, of whom 17 patients had undergone transcatheter aortic heart valve implantation, 19 had surgically prosthetic valves, and two had tetralogy of Fallot with transcatheter pulmonary valves. After ICE, 19 patients were classified with definite PVE, and four patients were treated as having PVE because of overall clinical presentation. Of the 15 patients not treated for endocarditis after ICE, one patient had a relapse. Regarding procedural safety, no vascular complications occurred, whereas six of the patients (16%) had groin hematomas, which did not require intervention and had no sequelae.CONCLUSIONS: Among patients with suspected PVE, ICE changed the diagnosis to definite PVE in half of the patients, with a low frequency of relapse among patients in whom PVE could not be confirmed by ICE. ICE may help guide clinicians in the duration of antibiotic treatment and surgical intervention in the treatment of patients with PVE.
AB - BACKGROUND: The use of transthoracic and transesophageal echocardiography may be challenging in patients suspected of having prosthetic valve endocarditis (PVE). Intracardiac echocardiography (ICE) provides a new diagnostic tool in the examination of patients with PVE, yet few data on its use have been published.METHODS: From January 2012 to December 2016, patients with suspected PVE and inconclusive findings on transthoracic and transesophageal echocardiography were further examined with ICE. Medical records were reviewed to assess clinical status, microbiologic etiology, echocardiography, antibiotic treatment, and surgical procedures. The modified Duke criteria were used to assess the diagnostic classification after ICE.RESULTS: A total of 38 patients suspected of having PVE were included, of whom 17 patients had undergone transcatheter aortic heart valve implantation, 19 had surgically prosthetic valves, and two had tetralogy of Fallot with transcatheter pulmonary valves. After ICE, 19 patients were classified with definite PVE, and four patients were treated as having PVE because of overall clinical presentation. Of the 15 patients not treated for endocarditis after ICE, one patient had a relapse. Regarding procedural safety, no vascular complications occurred, whereas six of the patients (16%) had groin hematomas, which did not require intervention and had no sequelae.CONCLUSIONS: Among patients with suspected PVE, ICE changed the diagnosis to definite PVE in half of the patients, with a low frequency of relapse among patients in whom PVE could not be confirmed by ICE. ICE may help guide clinicians in the duration of antibiotic treatment and surgical intervention in the treatment of patients with PVE.
KW - Diagnostic imaging
KW - Infective endocarditis
KW - Interventional cardiology
KW - Intracardiac echocardiography
KW - Prosthetic heart valve
UR - http://www.scopus.com/inward/record.url?scp=85072782054&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2019.06.016
DO - 10.1016/j.echo.2019.06.016
M3 - Journal article
C2 - 31587968
SN - 0894-7317
VL - 32
SP - 1558-1564.e3
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 12
ER -