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Role of echocardiography in the diagnosis and clinical management of infective endocarditis

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Abstract

Infective endocarditis (IE) is a deadly disease, constituting both diagnostic and treatment challenges. A positive outcome requires rapid and accurate diagnosis, and for that, echocardiography unequivocally remains the cornerstone. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have complementary roles and have been markedly improved during the last decades. The transthoracic modality is the recommended first-line approach but may only be sufficient in patients where the probability of IE is low and/or with clear acoustic windows, especially in patients with right-sided IE. The transesophageal modality is superior to TTE in most aspects and is recommended for all other patients. Both TTE and TEE may delineate vegetation location and size, assess for paravalvular extension of infection, and have the added advantage of defining the hemodynamic effects of valvular or device infection. However, echocardiography still has significant limitations, and novel imaging techniques are increasingly being exploited to improve diagnostic potential. Cardiac computed tomography (CT) performs better than TEE in the detection of abscess or pseudoaneurysm, while magnetic resonance imaging (MRI) has limited value in the diagnostic phase of IE but adds knowledge to the evaluation of extracardiac events. Nuclear molecular techniques are evolving as key supplementary methods in difficult-to-diagnose cases. Although newer imaging modalities are undergoing preliminary evaluation and multimodal imaging will play an increasing role in IE, echocardiography will continue to be pivotal in patients with IE for the foreseeable future.

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  1. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Jeppe Kofoed Petersen, Lauge Østergaard & Emil Loldrup Fosbøl

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JKP, LØ, and ELF contributed to the conception or design of the work. JKP, LØ, and ELF contributed to the acquisition, analysis, or interpretation of data for the work. JKP drafted the manuscript. LØ and ELF critically revised the manuscript. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

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Lauge Østergaard: Independent research grant from Novo Nordisk Foundation

Emil Fosbøl: Independent research grant from Novo Nordisk Foundation

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Petersen, J.K., Østergaard, L. & Fosbøl, E.L. Role of echocardiography in the diagnosis and clinical management of infective endocarditis. Indian J Thorac Cardiovasc Surg 40 (Suppl 1), 16–28 (2024). https://doi.org/10.1007/s12055-023-01668-4

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