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Malik SB, Hsu JY, Hurwitz Koweek LM, Ghoshhajra BB, Beache GM, Brown RKJ, Davis AM, Johri AM, Kligerman SJ, Litmanovich D, Mace SE, Maroules CD, Meyersohn N, Villines TC, Wann S, Weissman G, Abbara S. ACR Appropriateness Criteria® Infective Endocarditis. J Am Coll Radiol 2021; 18:S52-S61. [PMID: 33958118 DOI: 10.1016/j.jacr.2021.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
Infective endocarditis can involve a normal, abnormal, or prosthetic cardiac valve. The diagnosis is typically made clinically with persistently positive blood cultures, characteristic signs and symptoms, and echocardiographic evidence of valvular vegetations or valvular complications such as abscess, dehiscence, or new regurgitation. Imaging plays an important role in the initial diagnosis of infective endocarditis, identifying complications, prognostication, and informing the next steps in therapy. This document outlines the initial imaging appropriateness of a patient with suspected infective endocarditis and for additional imaging in a patient with known or suspected infective endocarditis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Sachin B Malik
- Research Author, VA Palo Alto Health Care System, Palo Alto, California and Stanford University, Stanford, California, Section Chief Thoracic and Cardiovascular Imaging, Director of Stress Cardiac MRI Program, Director of Cardiovascular CT and MRI.
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | - Lynne M Hurwitz Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina, Director, Cardiovascular Imaging, Medical Director of CT, Duke University Medical Center
| | | | - Garth M Beache
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah
| | - Andrew M Davis
- The University of Chicago Medical Center, Chicago, Illinois, American College of Physicians
| | - Amer M Johri
- Queen's University, Kingston, Ontario, Canada, Cardiology expert
| | | | - Diana Litmanovich
- Harvard Medical School, Boston, Massachusetts, Section Chief of the Cardiothoracic Section, Department of Radiology, Beth Israel Deaconess Medical Center; President of the North American Society for Cardiovascular Imaging and Co-Chair of Image Wisely
| | - Sharon E Mace
- Cleveland Clinic, Cleveland, Ohio, American College of Emergency Physicians
| | | | | | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia, Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin, Nuclear cardiology expert
| | - Gaby Weissman
- Medstar Washington Hospital Center, Georgetown University, Washington, District of Columbia, Society for Cardiovascular Magnetic Resonance, Medstar Heart and Vascular Institute, Associate Professor of Medicine and Radiology
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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Jensen J, Thaler C, Saxena R, Calcaterra D, Sanchez J, Orlandi Q, Harris KM. Transesophageal Echocardiography to Diagnose Watchman Device Infection. ACTA ACUST UNITED AC 2020; 4:189-194. [PMID: 32577603 PMCID: PMC7303240 DOI: 10.1016/j.case.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The authors report a rare case of infected Watchman device 4 months after placement. A high index of suspicion allowed timely diagnosis of Watchman device infection. Transesophageal echocardiography led to diagnosis of an infected Watchman device. High clinical morbidity is associated with Watchman device endocarditis.
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Affiliation(s)
- Joseph Jensen
- Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Christina Thaler
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Retu Saxena
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Domenico Calcaterra
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jason Sanchez
- Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Quirino Orlandi
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Kevin M Harris
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Pallás Beneyto LA, Rodríguez Luis O, Bayarri VM. [Infective endocarditis: the role of surgery]. Med Clin (Barc) 2011; 136:67-72. [PMID: 20045529 DOI: 10.1016/j.medcli.2009.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 10/15/2009] [Accepted: 10/22/2009] [Indexed: 11/16/2022]
Abstract
Infective endocarditis (IE) is a serious disease which can carry a bad prognosis if it is not appropriately treated. Sometimes the clinical evolution is unfavourable despite an optimal medical therapy with antibiotics. Surgery in these cases has an important role to eliminate the source of infection or to perform a valve replacement. The surprising evolution of patients operated in critic circumstances take us to analyze the role of early surgery. As physicians, we need to know these patients' risks and to establish the adequate surgical indications.
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Yildirimturk O, Tugcu A, Tayyareci Y, Polat B, Aytekin S. Mycotic Ascending Aortic Pseudoaneurysm Causing a Large Mediastinal Abscess. Echocardiography 2009; 26:729-31. [DOI: 10.1111/j.1540-8175.2008.00876.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Echocardiography, particularly transesophageal echocardiography (TEE), is a vital diagnostic and monitoring imaging modality for the intensivist. The field of echocardiography spans different venues and pathologies, ranging from surface transthoracic echocardiography and portable hand-held echocardiography, to contrast echocardiography, stress echocardiography, and TEE, among others. Numerous investigations have proven the worth of echocardiography, especially TEE, in the critically ill and injured patient, changing lives with the identification of obvious and subtle cardiothoracic diseases. Because this powerful imaging tool is immediately available and portable, crucial delays in diagnosis are not commonplace; rather than echocardiography, TEE, specifically, should be (and is in some institutions) the standard of care and management in assisting the intensivist in diagnosis of a variety of maladies. The effect of TEE technology is quite formidable, and numerous investigations have borne this out. The therapeutic effect of TEE ranges from 10% to 69%, with the majority of investigations falling into the 60% to 65% range. The diagnostic yield of TEE is far greater, approaching 78%. This article will detail the importance of echocardiography, its efficacy, and its high-yield imaging capability, particularly when compared with other imaging modalities, even transthoracic echocardiography.
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Affiliation(s)
- David T Porembka
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Harris KM, Ang E, Lesser JR, Sonnesyn SW. Cardiac Magnetic Resonance Imaging for Detection of an Abscess Associated with Prosthetic Valve Endocarditis: A Case Report. Heart Surg Forum 2007; 10:E186-7. [PMID: 17389206 DOI: 10.1532/hsf98.20061210] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Propionibacterium acnes is an organism frequently isolated in cultures and often dismissed as a contaminant. A patient with a febrile illness and prosthetic aortic valve was suspected of having infectious endocarditis. Magnetic resonance imaging was useful in defining a paravalvular abscess associated with prosthetic valve endocarditis due to Propionibacterium acnes that was then successfully surgically repaired.
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Affiliation(s)
- Kevin M Harris
- Minneapolis Heart Institute, Minneapolis, MN 55407, USA.
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Affiliation(s)
- Kathleen Marchiondo
- Kathleen Marchiondo is an assistant professor of nursing at the University of Central Missouri in Kansas City, where she teaches advanced medical-surgical and critical care nursing in the bachelor of science program in nursing
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Ruttmann E, Legit C, Poelzl G, Mueller S, Chevtchik O, Cottogni M, Ulmer H, Pachinger O, Laufer G, Mueller LC. Mitral valve repair provides improved outcome over replacement in active infective endocarditis. J Thorac Cardiovasc Surg 2005; 130:765-71. [PMID: 16153926 DOI: 10.1016/j.jtcvs.2005.03.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Revised: 02/22/2005] [Accepted: 03/10/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Mitral repair in active infective endocarditis still remains controversial. Several studies demonstrate the feasibility of mitral repair in infective endocarditis; however, superiority of repair has never been shown. The aim of the investigation was to compare valve repair and valve replacement in respect to the extent of destruction and to analyze survival, recurrent endocarditis, and reoperation (event-free survival). METHODS Sixty-eight consecutive patients underwent surgical intervention for mitral endocarditis. Thirty-four (50%) patients had valve repair, and 34 (50%) patients had valve replacement. Leaflet destruction involving at least one mitral leaflet was present in 15 (44.1%) patients of the repair group and 11 (32.4%) patients of the replacement group. Repair of the mitral annulus with pericardium was performed in 4 (11.8%) patients in the repair group and 3 (8.8%) patients in the replacement group. Patients in both groups were similar concerning the progression of valvular destructions and comorbidities. RESULTS Hospital mortality was 11.8% (8 patients). No significant differences were found in all baseline parameters, with the exception of a higher incidence of previous septic embolism and sepsis in the repair group. Actuarial event-free survival at 1 year was 88.2% in the repair group compared with 67.7% in the replacement group, and 5-year event-free survival was 80.4% in the repair group and 54.6% in the replacement group (P = .015). Mitral valve repair remained the superior treatment regarding event-free survival in the multivariate analysis (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .02). CONCLUSIONS Mitral valve repair offers excellent early and late results and is the preferable treatment option in the surgical therapy of native infective endocarditis.
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Affiliation(s)
- Elfriede Ruttmann
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
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Abstract
PURPOSE OF REVIEW Infective endocarditis continues to pose major challenges in diagnosis and management despite advances in understanding the epidemiology, microbiology, and pathology of the disease. The purpose of this article is to provide a review of diagnosis, microbiology, and treatment of infective endocarditis, particularly as they are influenced by case definitions. RECENT FINDINGS Case definitions have a critical effect on the interpretation of trends in infective endocarditis, and recent studies have proposed more specific criteria. Studies have also addressed the appropriate use of echocardiography to assist in the diagnosis and management of infective endocarditis. Staphylococcus aureus has become an increasingly common cause of infective endocarditis, and the microbiology of nosocomial infective endocarditis is changing. Newer techniques are being used to aid in the identification of causal agents in blood culture-negative infective endocarditis. Antimicrobial guidelines for the treatment of infective endocarditis are readily available, including a proposal to avoid premature discharge of patients on outpatient antibiotic therapy. Additional studies have been conducted on combination antibiotic therapy, duration of treatment, dosing of aminoglycosides, alternative agents for gram-positive organisms, aspirin therapy, and surgical interventions. SUMMARY Recent trends in diagnosis, microbiology, and treatment of infective endocarditis are described, and case definitions play a critical role in their interpretation.
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Affiliation(s)
- Roni K Devlin
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA
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