Role of cardiac catheterization in infective endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Diagnostic Imaging

Background:

• Acute infective endocarditis frequently presents with valvular insufficiency and heart failure.
• Diagnostic challenges arise in differentiating valvular dysfunction from other causes of heart failure.

Purpose of the Study:

• To evaluate the diagnostic utility and potential hazards of cardiac catheterization and angiography in patients with acute endocarditis and heart failure.
• To determine the specific clinical scenarios where these invasive procedures are most beneficial or potentially contraindicated.

Main Methods:

• Retrospective analysis of 19 patients with acute aortic and/or mitral endocarditis and heart failure.
• Invasive diagnostic procedures including cardiac catheterization and angiography were reviewed.
• Clinical diagnoses were compared with findings from diagnostic imaging.

Main Results:

• Bedside diagnosis of valvular insufficiency and heart failure was accurate in 74% of patients.
• Angiography clarified diagnoses in three patients with combined aortic and mitral valve disease.
• Four unsuspected aortic aneurysmal erosions were detected, but three were missed.
• Heart failure worsened post-angiography in two patients with severe aortic insufficiency, leading to one death.

Conclusions:

• Cardiac catheterization and angiography are most valuable in complex cases with multiple left-sided valve lesions, suspected extravalvular disease, or infection.
• These procedures may be unnecessary and potentially harmful in isolated mitral insufficiency or rapidly progressing severe aortic regurgitation.
• Careful patient selection is crucial to maximize benefits and minimize risks associated with these invasive diagnostic tools.