Three-dimensional Transesophageal Echocardiography in Prosthetic Valve Infective Endocarditis: Incremental Diagnostic...

The aim of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3DTEE) versus 2-dimensional transesophageal echocardiography (2DTEE) in the detection of prosthetic valve endocarditis (PVE), its prognostic value, and its peculiar diagnostic features compared to native valve endocarditis (NVE). One hundred and twenty-nine patients with infective endocarditis (64 PVE and 65 NVE), selected from a population of 195 patients with suspected PVE or NVE, were studied using 3DTEE and 2DTEE. Presence, location and size of vegetations, new or progressive valve regurgitation, perivalvular extension, and new dehiscence of valve prosthesis were assessed. A definite diagnosis of infective endocarditis was obtained by using 2023 Duke-ESC criteria. Significant improvement in global χ² value was noted with the addition of 3DTEE parameters compared with 2DTEE alone for PVE detection (from 81.7 to 92.3, p = 0.002) and for prediction of in-hospital mortality (from 79.3 to 86.7, p = 0.01). In patients with prosthetic valves and surgical confirmation of the diagnosis, 2DTEE and 3DTEE showed a sensitivity of 84.8% and 90.1%, a specificity of 74.2% and 84.3% (p = 0.001), a positive predictive value of 89.6% and 93.4%, and a negative predictive value of 76.3% and 85.6% (p = 0.003) for PVE detection. Regarding the detection of PVE- and NVE-related valvular and perivalvular lesions according to surgery findings, receiver operating characteristic (ROC) curve analysis showed similar diagnostic performance of 3-dimensional transesophageal echocardiography (3DTEE) for valvular complications (AUC = 0.727 vs 0.897, p = 0.704) and superior diagnostic performance for perivalvular complications, both in mechanical and biological prostheses (AUC = 0.831 vs 0.516, p = 0.012, and AUC = 0.836 vs 0.697, p = 0.026, respectively). These results were particularly marked in early PVE compared to late PVE (AUC = 0.883 vs 0.478, p = 0.001). Our results suggest that 3DTEE provides additional diagnostic and prognostic information for patients with PVE and higher diagnostic performance for perivalvular complications compared to NVE.