Lo Presti S, Elajami TK, Zmaili M, Reyaldeen R, Xu B. Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review. World J Cardiol 2021; 13(8): 254-270 [PMID: 34589164 DOI: 10.4330/wjc.v13.i8.254]
Corresponding Author of This Article
Bo Xu, MD, FRACP, FACC, FASE, Multimodality Imaging Cardiologist, Section of Cardiovascular Imaging in the Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute at Cleveland Clinic, Cleveland, OH 44195, United States. xub@ccf.org
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Evidence Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Aug 26, 2021; 13(8): 254-270 Published online Aug 26, 2021. doi: 10.4330/wjc.v13.i8.254
Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review
Saberio Lo Presti, Tarec K Elajami, Mohammad Zmaili, Reza Reyaldeen, Bo Xu
Saberio Lo Presti, Reza Reyaldeen, Advanced Cardiac Imaging Fellows, Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute at Cleveland Clinic, Cleveland, OH 44195, United States
Tarec K Elajami, Department of Cardiology, Mount Sinai Medical Center, Miami Beach, FL 33140, United States
Mohammad Zmaili, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Bo Xu, Section of Cardiovascular Imaging in the Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute at Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: All authors contributed to the literature review, drafting of the manuscript and approval of the final version.
Conflict-of-interest statement: All authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Xu, MD, FRACP, FACC, FASE, Multimodality Imaging Cardiologist, Section of Cardiovascular Imaging in the Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute at Cleveland Clinic, Cleveland, OH 44195, United States. xub@ccf.org
Received: March 11, 2021 Peer-review started: March 11, 2021 First decision: April 6, 2021 Revised: June 24, 2021 Accepted: July 26, 2021 Article in press: July 26, 2021 Published online: August 26, 2021
Abstract
Infective endocarditis is one of the leading life-threatening infections around the world. With the exponential growth in the field of transcatheter interventions and advances in specialized surgical techniques, the number of prosthetic valves and cardiac implantable devices has significantly increased. This has led to a steep rise in the number of cases of prosthetic valve endocarditis (PVE) comprising up to 30% of all cases. Clinical guidelines rely on the use of the modified Duke criteria; however, the diagnostic sensitivity of the modified Duke criteria is reduced in the context of PVE. This is in part attributed to prosthesis related artifact which greatly affects the ability of echocardiography to detect early infective changes related to PVE in certain cases. There has been increasing recognition of the roles of complementary imaging modalities and updates in international society recommendations. Prompt diagnosis and treatment can prevent the devastating consequences of this condition. Imaging modalities such as cardiac computed tomography and 18-fluorodeoxyglucose positron emission tomography/computed tomography are diagnostic tools that provide a complementary role to echocardiography in aiding diagnosis, pre-operative planning, and treatment decision-making process in these challenging cases. Understanding the strengths and limitations of these adjuvant imaging modalities is crucial for the implementation of appropriate imaging modalities in clinical practice.
Core Tip: Prosthetic valve endocarditis comprises up to 30% of all cases of infective endocarditis with a reported in-hospital mortality of 14%-22% and 1-year mortality as high as 40%. Its prompt diagnosis, although often challenging, is of critical importance to prevent deleterious consequences for patients. Advances in the field of 3-dimensional-echocardiography and the increased applications of adjuvant, complementary imaging modalities, including 18-fluorodeoxyglucose positron emission tomography/ computed tomography, have enhanced the diagnostic accuracy. In the present narrative review, we discuss the epidemiology, clinical manifestations, management principles, and advantages and limitations of various imaging modalities available for the diagnosis and management of prosthetic valve endocarditis.
