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Meta-Analysis
. 2015 Jul;25(7):2125-33.
doi: 10.1007/s00330-015-3605-7. Epub 2015 Feb 14.

Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? A systematic review and meta-analysis

Jesse Habets  1 , Wilco Tanis, Johannes B Reitsma, Renee B A van den Brink, Willem P Th M Mali, Steven A J Chamuleau, Ricardo P J Budde
Affiliations
Meta-Analysis

Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? A systematic review and meta-analysis

Jesse Habets et al. Eur Radiol. 2015 Jul.

Abstract

Objectives: Multimodal non-invasive imaging plays a key role in establishing a diagnosis of PHV endocarditis. The objective of this study was to provide a systematic review of the literature and meta-analysis of the diagnostic accuracy of TTE, TEE, and MDCT in patients with (suspected) PHV endocarditis.

Methods: Studies published between 1985 and 2013 were identified via search and cross-reference of PubMed/Embase databases. Studies were included if (1) they reported on the non-invasive index tests TTE, TEE, or MDCT; (2) data was provided on PHV endocarditis as the condition of interest; and (3) imaging results were verified against either surgical inspection/autopsy or clinical follow-up reference standards, thereby enabling the extraction of 2-by-2 tables.

Results: Twenty articles (including 496 patients) met the inclusion criteria for PHV endocarditis. TTE, TEE, and MDCT + TEE had a pooled sensitivity/specificity for vegetations of 29/100%; 82/95%, and 88/94%, respectively. The pooled sensitivity/specificity of TTE, TEE, and MDCT + TEE for periannular complications was 36/93%, 86/98%, and 100/94%, respectively.

Conclusions: TEE showed good sensitivity and specificity for establishing a diagnosis of PHV endocarditis. Although MDCT data are limited, this review showed that MDCT in addition to TEE may improve sensitivity in detecting life-threatening periannular complications.

Key points: • Multimodal imaging is an important ingredient of diagnostic workup for PHV endocarditis. • Transthoracic and transesophageal echography may miss life-threatening periannular complications. • MDCT can improve sensitivity for the detection of life-threatening periannular complications.

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Figures

Fig. 1
Fig. 1
Systematic literature search
Fig. 2
Fig. 2
Pooled sensitivity analysis of all studies for vegetations and periannular extensions
Fig. 3
Fig. 3
Pooled specificity analysis of all studies for vegetations and periannular extensions
Fig. 4
Fig. 4
Complementary value of MDCT + TEE. In this patient with a Carbomedics bileaflet PHV in the aortic position, TTE demonstrated severe aortic regurgitation. In addition, TEE and MDCT revealed a mycotic aortic root aneurysm directly below the right coronary artery (RCA) origin (a, c), with diastolic paravalvular leakage as seen on colour Doppler imaging (b). While acoustic shadowing on the TEE images (a) hampered complete and accurate assessment of the PHV, MDCT showed no vegetations (c). MDCT nicely demonstrated the close relationship between the mycotic aneurysm and the RCA (c, d). The location of the mycotic aneurysm is indicated by an asterisk on the schematic drawing (d). (Reprinted with permission [35])
See this image and copyright information in PMC

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