Diagnostic Work-Up in Patients with Nonbacterial Thrombotic Endocarditis

Area of Science:

• Cardiology
• Pathology

Background:

• Nonbacterial thrombotic endocarditis (NBTE) is a distinct form of endocarditis associated with specific predisposing conditions.
• Conditions include malignancies, autoimmune diseases (e.g., antiphospholipid antibody syndrome), and coagulation disturbances.
• NBTE is also known as marantic, verrucous, or Libman-Sacks endocarditis, though these terms denote clinical-pathological differences.

Purpose of the Study:

• To provide a comprehensive review of the clinical presentation and therapeutic strategies for NBTE.
• To focus specifically on the diagnostic tools and techniques used for NBTE.
• To differentiate NBTE from infective endocarditis.

Main Methods:

• Diagnosis relies primarily on echocardiography, particularly transesophageal echocardiography, as the gold standard.
• Comprehensive microbiological and serological tests are crucial to exclude infective endocarditis.
• Advanced imaging modalities like cardiac MRI and 18FDG-PET/CT are explored as adjunctive diagnostic tools.

Main Results:

• NBTE typically presents with embolic events.
• Valvular complications in NBTE are generally less frequent and milder than in infective endocarditis.
• Echocardiography is the primary diagnostic tool, with advanced imaging showing promise.

Conclusions:

• Accurate diagnosis of NBTE is essential, especially differentiating it from infective endocarditis.
• Echocardiography remains the cornerstone of diagnosis, supplemented by advanced imaging.
• Understanding the clinical nuances and diagnostic approaches is key for effective management.