Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review

Abstract

Infective endocarditis is one of the leading life-threatening infections around the world. With the exponential growth in the field of transcatheter interventions and advances in specialized surgical techniques, the number of prosthetic valves and cardiac implantable devices has significantly increased. This has led to a steep rise in the number of cases of prosthetic valve endocarditis (PVE) comprising up to 30% of all cases. Clinical guidelines rely on the use of the modified Duke criteria; however, the diagnostic sensitivity of the modified Duke criteria is reduced in the context of PVE. This is in part attributed to prosthesis related artifact which greatly affects the ability of echocardiography to detect early infective changes related to PVE in certain cases. There has been increasing recognition of the roles of complementary imaging modalities and updates in international society recommendations. Prompt diagnosis and treatment can prevent the devastating consequences of this condition. Imaging modalities such as cardiac computed tomography and ¹⁸-fluorodeoxyglucose positron emission tomography/computed tomography are diagnostic tools that provide a complementary role to echocardiography in aiding diagnosis, pre-operative planning, and treatment decision-making process in these challenging cases. Understanding the strengths and limitations of these adjuvant imaging modalities is crucial for the implementation of appropriate imaging modalities in clinical practice.

Keywords: Prosthetic valve endocarditis; Multimodality cardiac imaging; echocardiography; Cardiac computed tomography; 18-fluorodeoxyglucose photon emission tomography/computed tomography

Core Tip: Prosthetic valve endocarditis comprises up to 30% of all cases of infective endocarditis with a reported in-hospital mortality of 14%-22% and 1-year mortality as high as 40%. Its prompt diagnosis, although often challenging, is of critical importance to prevent deleterious consequences for patients. Advances in the field of 3-dimensional-echocardiography and the increased applications of adjuvant, complementary imaging modalities, including ¹⁸-fluorodeoxyglucose positron emission tomography/ computed tomography, have enhanced the diagnostic accuracy. In the present narrative review, we discuss the epidemiology, clinical manifestations, management principles, and advantages and limitations of various imaging modalities available for the diagnosis and management of prosthetic valve endocarditis.