|
1
|
Santarpino G, Lofrumento F, Zito C, Trio O, Restelli D, Cusmà Piccione M, Manganaro R, Carerj S, Cardetta F, Fiore C, de Gregorio C. Exploring the Complexities of Non-Bacterial Thrombotic Endocarditis: Highlights from Literature and Case Studies. J Clin Med 2024; 13:4904. [PMID: 39201046 PMCID: PMC11355671 DOI: 10.3390/jcm13164904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Non-bacterial thrombotic endocarditis (NBTE) is a form of non-infective endocarditis characterized by the deposition of sterile fibrin and platelets on cardiac valves. Even though some studies have identified important pathophysiological features, many aspects remain poorly understood. Given its wide availability, transthoracic echocardiography is typically the initial diagnostic approach to the patient. Additionally, recent technological advancements in transesophageal echocardiography, such as three-dimensional and multiplanar reconstruction analysis, have significantly improved diagnostic accuracy over time. By presenting our case series and performing a literature review, we focused on the main pathophysiologic, diagnostic, and therapeutic aspects of this rare but potentially life-threatening disease.
Collapse
Affiliation(s)
- Giuseppe Santarpino
- Department of Cardiac Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care and Research, 73100 Lecce, Italy;
- Department of Cardiac Surgery, Paracelsus Medical University, 40100 Nuremberg, Germany
| | - Francesca Lofrumento
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
| | - Olimpia Trio
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
| | - Davide Restelli
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
| | - Maurizio Cusmà Piccione
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
| | - Roberta Manganaro
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
| | - Francesco Cardetta
- Department of Cardiac Surgery, Campus Biomedico University, 00128 Rome, Italy;
| | - Corrado Fiore
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care and Research, 73100 Lecce, Italy;
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy; (F.L.); (C.Z.); (O.T.); (D.R.); (M.C.P.); (R.M.); (S.C.); (C.d.G.)
- Department of Emergency, G. Martino University Hospital, Cardiology Unit, 98122 Messina, Italy
| |
Collapse
|
|
2
|
Petkovic A, Menkovic N, Petrovic O, Bilbija I, Nisevic M, Radovanovic NN, Stanisavljevic D, Putnik S, Maksimovic R, Ivanovic B. Imaging in Infective Endocarditis-Current Opinions and Trends in Cardiac Computed Tomography. Diagnostics (Basel) 2024; 14:1355. [PMID: 39001245 PMCID: PMC11241025 DOI: 10.3390/diagnostics14131355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Infective endocarditis is a rare disease with an increasing incidence and an unaltered high mortality rate, despite medical development. Imaging plays an integrative part in the diagnosis of infective endocarditis, with echocardiography as the initial diagnostic test. Research data in the utility of cardiac computed tomography (CCT) in the diagnostic algorithm of IE are rising, which indicates its importance in detection of IE-related lesion along with the exclusion of coronary artery disease. The latest 2023 European Society of Cardiology Guidelines in the management of IE classified CCT as class of recommendation I and level of evidence B in detection of both valvular and paravalvular lesions in native and prosthetic valve endocarditis. This review article provides a comprehensive and contemporary review of the role of CCT in the diagnosis of IE, the optimization of acquisition protocols, the morphology characteristics of IE-related lesions, the published data of the diagnostic performance of CCT in comparison to echocardiography as the state-of-art method, as well as the limitations and future possibilities.
Collapse
Affiliation(s)
- Ana Petkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nemanja Menkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
| | - Ilija Bilbija
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Nisevic
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nikola N. Radovanovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Pacemaker Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Svetozar Putnik
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Branislava Ivanovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
| |
Collapse
|
|
3
|
Babes EE, Bustea C, Ilias TI, Babes VV, Luca SA, Luca CT, Radu AF, Tarce AG, Bungau AF, Bustea C. Multimodality Imaging Diagnosis in Infective Endocarditis. Life (Basel) 2023; 14:54. [PMID: 38255669 PMCID: PMC10821102 DOI: 10.3390/life14010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.
Collapse
Affiliation(s)
- Elena Emilia Babes
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Tiberia Ioana Ilias
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Victor Vlad Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Silvia-Ana Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Constantin Tudor Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alexandra Georgiana Tarce
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Alexa Florina Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
| |
Collapse
|