Diagnostic performance of cardiac computed tomography versus transesophageal echocardiography in infective endocarditis: A contemporary comparative meta-analysis |
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| Authors: | Vardhmaan Jain Tom Kai Ming Wang Agam Bansal Medhat Farwati Mohamed Gad Bryce Montane Simrat Kaur Michael A. Bolen Richard Grimm Brian Griffin Bo Xu |
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| Affiliation: | 1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA;2. Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA;3. Section of Cardiovascular and Thoracic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA;1. Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany;2. Department of Cardiology, University Medical Center Mainz, Johannes-Gutenberg University Mainz, Mainz, Germany;1. GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy;2. IRCCS San Raffaele Scientific Institute, Italy;3. Vita-Salute San Raffaele University, Italy;4. Guglielmo da Saliceto Hospital, Piacenza, Italy;5. Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy;6. Ospedale di Cremona, Cremona, Italy;7. Centro Cardiologico Monzino IRCCS, Milano, Italy;8. Ospedale Maggiore, Bologna, Italy;9. San Gerardo Hospital, Monza, Italy;10. ASST Bolognini Hospital, Bergamo Est, Italy;11. Parma University Hospital, Parma, Italy;12. ASST Valtellina and Alto Lario, “Eugenio Morelli Hospital”, Sondalo, Italy;13. San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy;14. Casa di Cura Villa dei Pini, Civitanova Marche, Italy;15. ICC Istituto Clinico Casalpalocco, Rome, Italy;p. San L. Mandic Hospital, Merate, Italy;q. ASST Papa Giovanni XXIII, Bergamo, Italy;1. Department of Cardiology - The Heart Center, University Hospital of Copenhagen - Rigshospitalet, Blegdamsvej 9, 2100-CPH, Denmark;2. Department of Radiology, University Hospital of Copenhagen - Rigshospitalet, Blegdamsvej 9, 2100-CPH, Denmark;1. Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Cardiology, Erlangen, Germany;2. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA;1. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA;2. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA;3. Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA;4. Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institute, Stockholm;5. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA;1. Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;2. Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;3. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA;4. Université Laval, Quebec City, Quebec, Canada;5. New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA |
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| Abstract: | ObjectiveTo compare the diagnostic accuracy of transesophageal echocardiography (TEE) and cardiac computed tomography (CCT) in diagnosing infective endocarditis (IE).BackgroundTEE is a mainstay imaging modality for IE, while the use of CCT is becoming increasingly prevalent. Data directly comparing the diagnostic performance of these two imaging modalities for IE are limited.MethodsWe conducted a systematic review and meta-analysis of published literature in Embase, PubMed and Cochrane databases through October 1, 2020 for studies comparing diagnostic performance of CCT and TEE for the diagnosis of IE in the same patient populations. A meta-analysis of diagnostic accuracy was performed using the bivariate model based on studies that used surgical pathology as a reference standard for defining endocarditis. From a total of 10 studies included in the meta-analysis, a total of 872 patients were evaluated.ResultsThe pooled sensitivities and specificities of TEE for detecting vegetations were 96% and 83% respectively, whereas for CCT, they were 85% and 84%, respectively. In the prosthetic valve sub-group, the pooled sensitivities and specificities of TEE for detecting vegetations were 89% and 74% respectively, whereas for CCT, they were 78% and 94%, with CCT being more specific than TEE (p < 0.05). The pooled sensitivities and specificities of TEE for detecting periannular complications were 70% and 96% respectively, whereas for CCT, they were 88% and 93%, respectively. CCT showed a trend (p = 0.06) towards higher sensitivity than TEE for detection of periannular complications. The pooled sensitivities and specificities of TEE for detecting leaflet perforation were 79% and 93% respectively, whereas for CCT, they were 48% and 93% respectively, with TEE being more sensitive (p < 0.05). The two modalities also showed comparable diagnostic performance for detecting fistulae, paravalvular leaks and prosthetic valve dehiscence.ConclusionIn a contemporary comparative meta-analysis, TEE and CCT demonstrated both good diagnostic accuracy for detecting valvular involvement and complications of IE. TEE performed better for detecting leaflet defects, whereas CCT performed better in cases of prosthetic valve involvement, and showed a trend towards improved detection of periannular complications. Appropriate, complementary use of both TEE and CCT in a multimodality imaging approach in clinical practice may achieve the highest diagnostic performance. |
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| Keywords: | Infective endocarditis Transesophageal echocardiography Computed tomography Diagnostic accuracy Systematic review Meta-analysis |
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