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Cardiac Magnetic Resonance Imaging for the Diagnosis of Infective Endocarditis in the COVID-19 Era

Sapan Bhuta1, Neha J Patel2, Jacob A Ciricillo2

  • 1Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Current Problems in Cardiology
|September 20, 2022
PubMed

Insights

Cardiac MRI (CMR) showed mixed results for diagnosing infective endocarditis (IE) vegetations, sometimes guiding treatment but occasionally missing diagnoses compared to TEE. Further trials are needed to compare CMR and TEE for IE diagnosis.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • The COVID-19 pandemic necessitated minimizing aerosol-generating procedures.
  • Transesophageal echocardiography (TEE) is a standard diagnostic tool for infective endocarditis (IE).
  • Cardiac magnetic resonance imaging (CMR) was explored as an alternative to TEE for IE diagnosis during the pandemic.

Purpose of the Study:

  • To evaluate the clinical utility of CMR in diagnosing infective endocarditis (IE).
  • To assess CMR's effectiveness in detecting valvular vegetations compared to established criteria and TEE.

Main Methods:

  • Retrospective study of 14 patients with suspected infective endocarditis (IE).
  • Patients met modified Duke Criteria or had positive blood cultures.
  • Clinical data, CMR findings, and TEE results (where available) were reviewed.

Main Results:

  • CMR identified possible vegetations in 2 cases, guiding further management.
  • CMR missed vegetations in 2 cases, which were later detected by TEE.
  • CMR was non-diagnostic in 3 cases; 7 patients were treated for IE with no significant difference in outcomes or antibiotic duration.

Conclusions:

  • Cardiac MRI (CMR) has limitations in diagnosing valvular vegetations for infective endocarditis (IE).
  • CMR showed mixed results in guiding clinical decisions for IE.
  • Prospective controlled trials comparing CMR and TEE for IE diagnosis are warranted.

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