Role of preoperative cardiac CT in the evaluation of infective endocarditis: comparison with transesophageal echocardiography and surgical findings

Infective endocarditis (IE) affects approximately 15,000 individuals in the United States annually. The diagnosis of IE is devastating with up to 40% risk of mortality (1). Early recognition and accurate diagnosis is paramount for the care of patients with IE who will often need surgery in addition to antibiotic therapy. Transesophageal echocardiography (TEE) is typically the imaging study of choice to assess valvar involvement in IE (2). TEE offers excellent temporal and spatial resolution and is free of ionizing radiation. The important role of TEE in diagnosing IE has been enshrined in the modified Duke criteria (3). In contrast, computed tomography (CT), typically plays a supportive role in imaging assessment of the heart and valves. However, use of this modality for evaluating IE has been increasing especially with the introduction of high resolution electrocardiogram (ECG) synchronized multiphasic (4D) acquisition (4-9). Recently, The European Society of Cardiology incorporated the use of cardiac CT in its guideline for management of IE (10)