Abstract
Introduction: Infective endocarditis (IE), particularly prosthetic valve endocarditis (PVE) and cardiac device-related endocarditis (CDIE), presents significant diagnostic challenges. The efficacy of intra-cardiac echocardiography (ICE) for diagnosing IE and assessing intra-cardiac infections when transesophageal echocardiography (TEE) is contraindicated, is not extensively studied. Methods: We searched six databases, including PubMed, Embase, Scopus, Ovid, Science Direct, and Web of Science, for articles published between September 2002 and November 2022, related to the utility of ICE in IE. Eligibility screening followed the search. Results: From the 12 identified studies discussing ICE for IE diagnosis, ten cases of IE were highlighted in nine reports, and three cohort studies included 236 patients without individual patient details. ICE was not used in any native valve IE case. Predominantly male patients (90%) had a median age of 42 years, developing endocarditis 2.5 years post initial cardiac procedure. The most common microorganisms identified were Staphylococcus species. ICE proved beneficial in various scenarios, particularly PVE and CDIE, especially when echocardiography studies were inconclusive or contraindicated. As an alternative to TEE, ICE offers clear visualization of right heart structure, guiding interventions such as pacemaker lead extractions. It excels in detecting device lead abnormalities and small vegetations in CDIE cases, supporting risk stratification and preparation for infected device extraction. Notably, all PVE cases involved bioprosthetic valves, affecting various heart structures and valves. Conclusion: This systematic review highlights ICE as an adjunct imaging modality in IE, especially in PVE and CDIE when TEE is contraindicated. Preliminary data suggest its valuable role during intracardiac lead extractions.
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