Table 1.
Imaging and laboratory techniques used in the diagnosis of infective endocarditis.
| Transthoracic echocardiography (TTE) | Mainstay of diagnosis. Limited sensitivity in prosthetic valve endocarditis and paravalvular complications. |
| Transesophageal echocardiography (TOE) | Mainstay of diagnosis. Indicated in prosthetic valve endocarditis and for the detection and characterization of valvular and paravalvular complications. |
| Three-dimensional transesophageal echocardiography (3D-TOE) | Complement to TOE when characterizing valvular and paravalvular complications. Surgical planning |
| Intraoperative transesophageal echocardiography | Routine exploration when surgery is performed. Assessment of post-operative anatomy and ventricular function. |
| Cardiac computed tomography (CT) | Better characterization of complications involving an aortomitral fibrous body and the aortic root. Alternative to coronary angiography for exploration in patients with aortic endocarditis. |
| Positron emission tomography/computed tomography (PET/CT) | Major Duke criteria for diagnosis of prosthetic valve endocarditis and device-associated endocarditis. Increasing use in infective endocarditis associated with TAVI and LVAD. Detection of extracardiac complications of endocarditis or alternative sources of infection. |
| Radiolabeled white blood cell single-photon emission computed tomography/computed tomography (WBC-SPECT/CT) | Complement to PET/CT when results are non-conclusive. Similar performance to that of PET/CT. |
| Brain magnetic resonance imaging (MRI) | Detection and characterization of silent or clinically evident intracranial complications. Evaluation of evolving changes in intracranial complications that may influence the timing for surgery. |
| Thoracoabdominopelvic computed tomography | Not recommended as a routine exploration in asymptomatic patients. |
| Contrast-enhanced ultrasound | Promising results on detecting intraabdominal emboli as an alternative to CT. |
| Colonoscopy | Detection of colorectal disease or neoplastic processes in Streptococcus gallolyticus or Enterococcus faecalis endocarditis. |
| Culture and polymerase chain reaction of samples from explanted heart valves | Improves the diagnostic performance of the Duke criteria. |
| Serum cytokine profiles and bacteria-targeting tracers | Under research; not routinely used. |
TAVI, transcatheter aortic valve implantation; LVAD, left-ventricle assistance devices.