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7 Complementary diagnostic and prognostic role of cardiac CT in surgically proven prosthetic valve endocarditis
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7 Complementary diagnostic and prognostic role of cardiac CT in surgically proven prosthetic valve endocarditis
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Journal Article
7 Complementary diagnostic and prognostic role of cardiac CT in surgically proven prosthetic valve endocarditis
2025
Overview
IntroductionCardiac computed tomography (CCT) is recommended in prosthetic infective endocarditis (IE) and has been shown to have prognostic significance, although in practice its use is limited. We aimed to assess for prognostic markers from CCTin surgically proven prosthetic valve endocarditis.MethodThis is a retrospective analysis of patients with surgically proven endocarditis who underwent CCT and TOE, identified from prospective institutional database between Feb 2016- July2023. Imaging findings related to endocarditis from TOE, CT and FDG PET and significant ancillary findings affecting surgical planning on CCT were recorded.ResultsFifty-two patients who underwent both CCT and TOE before surgery were included, 8 (15%) patients underwent FDG PET in addition. Patient characteristics are summarised in table 1. 6 deaths occurred before discharge (in hospital mortality rate 11.5%). The cases discharged alive were followed up for a median of 50 (IQR 31–78) months.CTCA had a sensitivity of 86.2% and specificity of 95.2% for surgically confirmed vegetations. CCT had a sensitivity of 81.6% and a specificity of 90.9% for surgically confirmed paravalvular involvement as opposed to a sensitivity of 97.4% and a specificity of 72.7% for TOE. FDG PET had a sensitivity of 75%. Ancillary findings identified in 24 (46%).Univariable logistic regression analysis was done for clinical and imaging parameters from CCT, TOE and FDG PET for occurrence of death. Multivariable regression analysis adjusted for gender, previous endocarditis, prosthetic valves, intracardiac device, blood cultures, diabetes and stroke. This showed odds ratio (OR) for ancillary findings on CT of 4.026, OR of 3.629 for paravalvular findings on CT; none reached statistical significance. Table 2 shows regression analysis results.ConclusionCardiac CT has complementary diagnostic and prognostic role to TOE
Publisher
BMJ Publishing Group LTD
Subject
