Restricted Use of Echocardiography in Suspected Endocarditis during COVID-19 Lockdown: A Multidisciplinary Team...

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• Infective endocarditis (IE) management is complicated by COVID-19 restrictions, particularly concerning echocardiography and virus transmission risks.
• This study investigated the role of the endocarditis team (ET) in reducing routine echocardiography, especially transesophageal echocardiography (TOE), during the pandemic.
• The impact of these changes on clinical outcomes for patients with suspected IE was explored.

Purpose of the Study:

• To assess the utilization of the endocarditis team (ET) in limiting echocardiography for suspected infective endocarditis (IE) during COVID-19 lockdown.
• To explore the effect of restricted echocardiography on the diagnostic capabilities of the Modified Duke Criteria.
• To determine the impact of ET-guided echocardiography restriction on all-cause mortality in patients with suspected IE.

Main Methods:

• An observational study was conducted at Imperial College Healthcare NHS Trust during the UK's first COVID-19 lockdown (March 23–July 8, 2020).
• All patients discussed at the endocarditis team (ET) meeting during this period were prospectively included.
• Data on echocardiography utilization and clinical outcomes were collected and analyzed.

Main Results:

• 38 patients with suspected IE were reviewed by the ET; 21% had no echo, 16% had point-of-care ultrasound only, and 63% had transthoracic echocardiography (TTE).
• Only 16% of patients underwent transesophageal echocardiography (TOE).
• While echocardiography significantly aided IE diagnosis (p=0.0099), sensitivity was unaffected. All-cause mortality was 17% at 30 days and 25% at 12 months for confirmed IE cases.

Conclusions:

• Restricting echocardiography in patients with low pretest probability for IE did not compromise the diagnostic ability of the Modified Duke Criteria to rule out IE.
• The use of the endocarditis team (ET) to limit nonessential echocardiography, including TOE, did not negatively impact all-cause mortality in suspected IE patients.
• ET guidance can help optimize echocardiography use in suspected IE during public health crises without adversely affecting patient outcomes.