imaging infective endocarditis: adherence to a diagnostic flowchart and direct comparison of imaging techniques

Multimodality imaging is recommended to diagnose infective endocarditis. value of additional imaging to echocardiography in patients selected by a previously proposed flowchart has not been evaluated. an observational single-center study was performed. adult patients suspected of endocarditis/device infection were prospectively and consecutively enrolled from 2016 to 2017. adherence to a diagnostic imaging-in-endocarditis-flowchart was evaluated in 176 patients. imaging techniques were compared head-to-head in 46 patients receiving echocardiography (transthoracic plus transesophageal), multi-detector computed tomography angiography (mdcta), and 18f-fluorodeoxyglucose positron emission tomography (fdg-pet/ct). 69% of patients (121/176) adhered to the flowchart. sensitivity of echocardiography, mdcta, fdg-pet/ct in patients without prosthesis was 71%, 57%, 29% (86% when combined), while specificity was 100%, 75%, 100%, respectively. sensitivity in patients with prosthesis was 75%, 75%, 83%, respectively (100% when combined), while specificity was 86% for all three modalities. echocardiography performed best in the assessment of vegetations, morphological valve abnormalities/dehiscence, septum defects, and fistula formation. mdcta performed best in the assessment of abscesses and ventricular assist device infection. fdg-pet/ct performed best in the assessment of cardiac device infection, extracardiac infectious foci, and alternative diagnoses. this study demonstrates that the evaluated imaging-in-endocarditis-flowchart is applicable in daily clinical practice. echocardiography, mdcta, and fdg-pet/ct provide relevant complementary diagnostic information, particularly in patients with intracardiac prosthetic material.