Avances en el diagnóstico por imagen de la endocarditis infecciosa izquierda

Abstract

Infective endocarditis remains a clinical condition that requires early detection due to its high mortality rate. Diagnosis is based on clinical, microbiological and echocardiographic findings. Nevertheless, in some scenarios, such as prosthetic endocarditis, the diagnostic performance of echocardiography is limited. For this reason, recent clinical practice guidelines recommend the use of alternative imaging techniques to assist in the evaluation of doubtful cases. Three-dimensional transesophageal echocardiography has shown to be useful in improving the accuracy to measure and locate the signs of endocarditis. Likewise, due to the absence of the acoustic window limitation, cardiac computed tomography has become a valuable technique to evaluate peri-annular complications of endocarditis. Several radiotracers have been used in nuclear medicine to detect the inflammatory/infectious activity in endocarditis. Even though positron emission tomography with 18-fluorodeoxyglucose has demonstrated an outstanding sensitivity to visualize signs of infection in prosthetic valves, it still has not been shown to be as useful in native valves. Although scintigraphy with labelled leucocytes is a laborious technique, it has shown an excellent specificity in previous studies. Finally, there is no current evidence to support the routine use of cardiac magnetic resonance in endocarditis; nevertheless, tissue characterisation is an interesting research area.