Comparison of Cardiac Computed Tomography with Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients with Infective Endocarditis in the Era of 3-Dimensional Images

In Cheol Kim, Suyon Chang, Geu Ru Hong, Seung Hyun Lee, Sak Lee, Jong Won Ha, Byung Chul Chang, Youngjin Kim, ChiYoung Shim

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background - Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE). Methods and Results - Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (r=0.593; P<0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism (r=0.608; P<0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated (r=0.187; P=0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess. Conclusions - Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.

Original languageEnglish
Article number006986
JournalCirculation: Cardiovascular Imaging
Volume11
Issue number3
DOIs
Publication statusPublished - 2018 Mar 1

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Transesophageal Echocardiography
Endocarditis
Tomography
Abscess
Fistula
False Aneurysm
Embolism
Aneurysm
Coronary Artery Disease

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{589851562e9c460697eb58f37dd612c5,
title = "Comparison of Cardiac Computed Tomography with Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients with Infective Endocarditis in the Era of 3-Dimensional Images",
abstract = "Background - Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE). Methods and Results - Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3{\%} and 72.0{\%}, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (r=0.593; P<0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism (r=0.608; P<0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8{\%}) compared with TEE (94.4{\%}), and the sizes of the 2 modalities were poorly correlated (r=0.187; P=0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess. Conclusions - Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.",
author = "Kim, {In Cheol} and Suyon Chang and Hong, {Geu Ru} and Lee, {Seung Hyun} and Sak Lee and Ha, {Jong Won} and Chang, {Byung Chul} and Youngjin Kim and ChiYoung Shim",
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Comparison of Cardiac Computed Tomography with Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients with Infective Endocarditis in the Era of 3-Dimensional Images. / Kim, In Cheol; Chang, Suyon; Hong, Geu Ru; Lee, Seung Hyun; Lee, Sak; Ha, Jong Won; Chang, Byung Chul; Kim, Youngjin; Shim, ChiYoung.

In: Circulation: Cardiovascular Imaging, Vol. 11, No. 3, 006986, 01.03.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of Cardiac Computed Tomography with Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients with Infective Endocarditis in the Era of 3-Dimensional Images

AU - Kim, In Cheol

AU - Chang, Suyon

AU - Hong, Geu Ru

AU - Lee, Seung Hyun

AU - Lee, Sak

AU - Ha, Jong Won

AU - Chang, Byung Chul

AU - Kim, Youngjin

AU - Shim, ChiYoung

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background - Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE). Methods and Results - Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (r=0.593; P<0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism (r=0.608; P<0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated (r=0.187; P=0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess. Conclusions - Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.

AB - Background - Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE). Methods and Results - Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (r=0.593; P<0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism (r=0.608; P<0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated (r=0.187; P=0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess. Conclusions - Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.

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