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Comparison of Cardiac Computed Tomography With Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients With Infective Endocarditis in the Era of 3-Dimensional Images.

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Author(s)
In-Cheol KimSuyon ChangGeu-Ru HongSeung Hyun LeeSak LeeJong-Won HaByung-Chul ChangYoung Jin KimChi Young Shim
Keimyung Author(s)
Kim, In Cheol
Department
Dept. of Internal Medicine (내과학)
Journal Title
Circulation. Cardiovascular Imaging
Issued Date
2018
Volume
11
Issue
3
Keyword
echocardiographyendocarditishumansimagingthree-dimensional
Abstract
BACKGROUND:

Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE).

METHODS AND RESULTS:

Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (r=0.593; P<0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism (r=0.608; P<0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated (r=0.187; P=0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess.

CONCLUSIONS:

Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.
Keimyung Author(s)(Kor)
김인철
Publisher
School of Medicine (의과대학)
Citation
In-Cheol Kim et al. (2018). Comparison of Cardiac Computed Tomography With Transesophageal Echocardiography for Identifying Vegetation and Intracardiac Complications in Patients With Infective Endocarditis in the Era of 3-Dimensional Images. Circulation. Cardiovascular Imaging, 11(3), e006986–e006986. doi: 10.1161/CIRCIMAGING.117.006986
Type
Article
ISSN
1941-9651
Source
https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.117.006986
DOI
10.1161/CIRCIMAGING.117.006986
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41142
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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