Structured Abstract
Objective
To compare the diagnostic accuracy of transesophageal echocardiography (TEE) and cardiac
computed tomography (CCT) in diagnosing infective endocarditis (IE).
Background
TEE is a mainstay imaging modality for IE, while the use of CCT is becoming increasingly
prevalent. Data directly comparing the diagnostic performance of these two imaging
modalities for IE are limited.
Methods
We conducted a systematic review and meta-analysis of published literature in Embase,
PubMed and Cochrane databases through October 1, 2020 for studies comparing diagnostic
performance of CCT and TEE for the diagnosis of IE in the same patient populations.
A meta-analysis of diagnostic accuracy was performed using the bivariate model based
on studies that used surgical pathology as a reference standard for defining endocarditis.
From a total of 10 studies included in the meta-analysis, a total of 872 patients
were evaluated.
Results
The pooled sensitivities and specificities of TEE for detecting vegetations were 96%
and 83% respectively, whereas for CCT, they were 85% and 84%, respectively. In the
prosthetic valve sub-group, the pooled sensitivities and specificities of TEE for
detecting vegetations were 89% and 74% respectively, whereas for CCT, they were 78%
and 94%, with CCT being more specific than TEE (p < 0.05). The pooled sensitivities
and specificities of TEE for detecting periannular complications were 70% and 96%
respectively, whereas for CCT, they were 88% and 93%, respectively. CCT showed a trend
(p = 0.06) towards higher sensitivity than TEE for detection of periannular complications.
The pooled sensitivities and specificities of TEE for detecting leaflet perforation
were 79% and 93% respectively, whereas for CCT, they were 48% and 93% respectively,
with TEE being more sensitive (p < 0.05). The two modalities also showed comparable
diagnostic performance for detecting fistulae, paravalvular leaks and prosthetic valve
dehiscence.
Conclusion
In a contemporary comparative meta-analysis, TEE and CCT demonstrated both good diagnostic
accuracy for detecting valvular involvement and complications of IE. TEE performed
better for detecting leaflet defects, whereas CCT performed better in cases of prosthetic
valve involvement, and showed a trend towards improved detection of periannular complications.
Appropriate, complementary use of both TEE and CCT in a multimodality imaging approach
in clinical practice may achieve the highest diagnostic performance.
Keywords
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Article info
Publication history
Published online: November 30, 2020
Accepted:
November 26,
2020
Received in revised form:
November 25,
2020
Received:
July 17,
2020
Identification
Copyright
© 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
