Beyond Standard Echocardiography in Infective Endocarditis: Computed Tomography, 3-Dimensional Imaging, and Multi-Imaging.

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Infective endocarditis (IE) is a complex disease, which associates cardiac localization and multiorgan complications, resulting in a challenging management.1 Prognosis depends on a prompt diagnosis and an adapted therapy that includes antibiotic therapy and early cardiac surgery when indicated.2 The diagnosis is made on the basis of multiple findings rather than a single definitive test result.3 In 1981, Von Reyn et al4 defined IE as suspected by clinical signs and persistent positive blood cultures and confirmed by direct evidence based on histology from surgery or autopsy or on bacteriology of valve vegetation or peripheral embolism. Since then, imaging of cardiac lesions appeared to be indispensable, and the Duke criteria by Durack et al5 introduced the endocardial involvement evidenced by echocardiography as a major diagnostic criterion. In 2000, the modified Duke criteria published by Li et al3 endorsed the widespread use of transesophageal echocardiography (TEE) in the field of IE diagnosis. Later, and in parallel with the improvement in computed tomography (CT) and nuclear imaging techniques, the use of both these modalities appeared useful and of particular interest for IE diagnosis.6,7 See Article by Kim et al In this issue of Circulation: Cardiovascular Imaging , Kim et al8 report their experience in the use of cardiac CT angiography (CTA) in patients with IE in the era of 3-dimensional images. Although recent guidelines or scientific statements recognized the role of multi-imaging in the diagnosis of left-sided IE,9–11 only a few publications have compared the value of TEE and cardiac CTA in the detection of IE-related cardiac lesion. Kim et al present an original work in which they attempted to answer the current question: Is the diagnostic performance of cardiac CTA better than TEE for detecting vegetation and IE-related cardiac …