Related Experiment Video
Updated: Aug 5, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Whole-body computed tomography's role in redefining left-sided infective endocarditis diagnosis and management
Małgorzata Misztal-Ogonowska1, Maciej Grabowski2, Karina Zatorska2
1Department of Valvular Heart Disease, Cardinal Stefan Wyszynski National Institute of Cardiology, Warszawa, Poland. mmisztal@ikard.pl.
Insights
Whole-body computed tomography (WB-CT) significantly improves the detection of embolic and perivalvular complications in left-sided infective endocarditis (LS-IE). This advanced imaging strategy also alters surgical indications, prioritizing embolism prevention in patients with LS-IE.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) poses significant risks, including septic embolism, heart failure, and perivalvular complications, often necessitating surgical intervention.
- Left-sided IE (LS-IE) presents specific diagnostic challenges and management complexities.
Purpose of the Study:
- To assess the impact of integrating whole-body computed tomography (WB-CT) into the diagnostic workflow for LS-IE.
- To evaluate WB-CT's effectiveness in detecting embolic and perivalvular complications and influencing surgical decisions.
Main Methods:
- Retrospective analysis of 366 patients diagnosed with LS-IE between 2015 and 2024.
- Classification of patients based on whether WB-CT (brain, chest, abdomen) was performed during their hospital stay.
Main Results:
- WB-CT was utilized in 132 patients (36.1%), revealing higher rates of extracardiac embolic complications compared to standard protocols.
- Perivalvular pseudoaneurysms were more frequently identified by CT than echocardiography.
- In operated patients who underwent WB-CT, embolism prevention emerged as the primary surgical indication (47.9%) compared to the non-WB-CT group (23.0%).
Conclusions:
- WB-CT enhances the detection of embolic and perivalvular complications in LS-IE patients.
- The adoption of WB-CT shifts surgical indications towards prioritizing embolism prevention.
Background:
Septic embolism, heart failure, perivalvular involvement, and uncontrolled infection are common complications of infective endocarditis (IE) and frequent indications for surgery.
Aims:
We evaluated the impact of introducing whole‑body computed tomography (WB‑CT; brain, chest, abdomen) into the diagnostic work-up of patients with left‑sided IE (LS-IE) on detection of embolic and perivalvular complications and on surgical indications.
Methods:
We retrospectively analyzed 366 patients admitted with LS-IE from 2015 to 2024. Patients were classified according to whether WB-CT was performed during hospitalization.
Results:
Of 366 patients, 132 (36.1%) underwent WB‑CT. Mean age was 57.9 (15.7) years, 79.8% were men, and surgery was performed in 268 patients (73.2%). Among patients who underwent WB-CT, embolic complications occurred in the spleen in 56 (42.4%), the brain in 28 (21.2%), and other sites in 23 (17.4%). The WB-CT strategy detected extracardiac embolic complications more often than the non-WB-CT protocol at each site (P <0.001). Perivalvular pseudoaneurysms were identified more frequently on CT than on echocardiography (P = 0.008). Among operated patients with WB‑CT (n = 94; 35.1%), embolism prevention was the main indication (47.9% vs. 23.0%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.80-5.26; P <0.001). By contrast, heart failure predominated in the non-WB-CT group (47.1% vs. 19.1%; OR, 0.26; 95% CI, 0.15-0.48; P <0.001).
Conclusions:
WB-CT was associated with a higher detection of embolic and perivalvular complications in LS-IE and with a different pattern of surgical indications, with embolism prevention more frequent in the WB-CT group.
More Related Videos
08:13In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
09:32Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
Published on: December 9, 2021
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:24Cardiac Catheterization III: Left Heart Catheterization
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...