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Echocardiography in infective endocarditis

  • Diagnosis: value and pitfalls, presented by F Flachskampf (Uppsala, SE) - Slides
  • Complications, presented by C Naber (Essen, DE) - Slides 
  • Three-dimensional echocardiography in decision making, presented by P Gutierrez-Fajardo (Guadalajara, MX) - Slides
  • Right sided infective endocarditis, presented by J A San Roman Calvar (Valladolid, ES)
Infective Endocarditis

Infective endocarditis (IE) is a life-threatening pathology, with important morbidity and mortality rates. Echocardiography has become a most important tool in the diagnosis of the disease, hence the importance of this symposium.

Diagnosis: value and pitfalls

Diagnosis of IE should start by careful evaluation of the clinical history and signs. This was emphasized by Dr Flachskampf, from Uppsala, Sweden, who discussed the value and the pitfalls, which he divided into “too much” and “too little” (vegetations, abscesses, etc). TEE has an important role to play, complementing the TTE. The diagnosis is not always straight forward and final evaluation should include laboratory data (culture, biomarkers, serology, PCR, etc) and, eventually, confirmed at surgery by valve analysis. The recent ESC guidelines on IE constitute a good basis for the discussion and management of the disease.


Dr Naber, from Essen, Germany, discussed the role of echocardiography in the diagnosis of the common complications from IE, resulting mainly from embolism or from uncontrolled infection. Cerebral hemorrhage, stroke, sepsis, abscesses, fistulae, valve destruction and regurgitation increase the morbidity and mortality. Some echocardiographic features may predict evolution of the disease and help deciding timing and type of intervention. Echo is also very important in the follow-up under therapy to monitor evolution of the disease.

Three-dimensional echocardiography in decision making

Dr Gutierres-Fajardo, from Mexico, discussed the role of the 3-Dimensional echo. This recently developed tool helps in the definition of the structures and the defects, which is better than 2-D echo. It appears especially useful in the preparation for and evaluation of surgery because its images are “realistic and resemble the true anatomy”. Mobile nodules are particularly well defined by 3-D echo, finally giving a better correlation with surgical findings. Another field where it can be most useful is in the evaluation of prosthetic endocarditis.

Right sided infective endocarditis

Finally, Dr San Román-Calvar, from Valladolid, Spain, addressed the unique features of right-sided endocarditis, that he considers a “different disease”, which have implications in the echo approach. It involves mostly the tricuspid valve, occurs in drug users, usually young and immune-compromised. The infecting agents are different and Satph aureus is the most common. Echocardiography often finds normal structures which may mimic vegetations, making the diagnosis of IE difficult. Artificial structures, such as leads and IV lines, are often infected and the differential diagnosis with vegetations is challenging. TTE is a good tool here because the acoustic window is better in these more anterior chambers and structures, but TEE is mandatory in patients with cardiac devices.

Overall, an excellent session with very lively discussion




Echocardiography in infective endocarditis

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.