Tricuspid valve endocarditis:Cardiovascular imaging evaluation and management

Right-sided infective endocarditis is an increasingly recognized disease entity,with tricuspid valve being most frequently involved.Risk factors for tricuspid valve endocarditis(TVIE)include intravenous drug use,cardiac implantable electronic devices and indwelling catheters.Staphylococcus aureus is the predominant causative organism in TVIE.The diagnosis of infective endocarditis(IE)is based on clinical manifestations,blood cultures,and the presence of valvular vegetations detected by echocardiography.Complementary imaging is helpful when there is ongoing clinical suspicion for IE following initially negative echocardiography.Multislice computed tomography allows for assessment of extra-cardiac complications in TVIE,including pulmonary septic emboli.18F-fluorodeoxyglucose positron emission tomography/computed tomography and radiolabelled white blood cell,single-photon emission computed tomography provide important clinical information concerning the presence of IE in right-sided prosthetic valves or cardiac implantable electronic devices.The aim of this review is to provide an update on TVIE,discussing the role of multimodality imaging in TVIE and the management of these patients.

Expanding utility of cardiac computed tomography in infective endocarditis: A contemporary review

There is increasing evidence on the utility of cardiac computed tomography(CCT)in infective endocarditis(IE)to investigate the valvular pathology,the extracardiac manifestations of IE and pre-operative planning.CCT can assist in the diagnosis of perivalvular complications,such as pseudoaneurysms and abscesses,and can help identify embolic events to the lungs or systemic vasculature.CCT has also been shown to be beneficial in the pre-operative planning of patients by delineating the coronary artery anatomy and the major cardiovascular structures in relation to the sternum.Finally,hybrid nuclear/computed tomography techniques have been shown to increase the diagnostic accuracy in prosthetic valve endocarditis.This manuscript aims to provide a contemporary update of the existing evidence base for the use of CCT in IE.

Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis:A contemporary narrative review

Infective endocarditis is one of the leading life-threatening infections around the world.With the exponential growth in the field of transcatheter interventions and advances in specialized surgical techniques,the number of prosthetic valves and cardiac implantable devices has significantly increased.This has led to a steep rise in the number of cases of prosthetic valve endocarditis(PVE)comprising up to 30%of all cases.Clinical guidelines rely on the use of the modified Duke criteria;however,the diagnostic sensitivity of the modified Duke criteria is reduced in the context of PVE.This is in part attributed to prosthesis related artifact which greatly affects the ability of echocardiography to detect early infective changes related to PVE in certain cases.There has been increasing recognition of the roles of complementary imaging modalities and updates in international society recommendations.Prompt diagnosis and treatment can prevent the devastating consequences of this condition.Imaging modalities such as cardiac computed tomography and 18-fluorodeoxyglucose positron emission tomography/computed tomography are diagnostic tools that provide a complementary role to echocardiography in aiding diagnosis,pre-operative planning,and treatment decisionmaking process in these challenging cases.Understanding the strengths and limitations of these adjuvant imaging modalities is crucial for the implementation of appropriate imaging modalities in clinical practice.

Multi-modality imaging of cardiac amyloidosis: Contemporary update

Cardiac amyloidosis is a heterogeneous and challenging diagnostic disease with poor prognosis that is now being altered by introduction of new therapies.Echocardiography remains the first-line imaging tool, and when disease is suspected on echocardiography, cardiac magnetic resonance imaging and nuclear imaging play critical roles in the non-invasive diagnosis and evaluation of cardiac amyloidosis. Advances in multi-modality cardiac imaging allowing earlier diagnosis and initiation of novel therapies have significantly improved the outcomes in these patients. Cardiac imaging also plays important roles in the risk stratification of patients presenting with cardiac amyloidosis. In the current review, we provide a clinical and imaging focused update, and importantly outline the imaging protocols, diagnostic and prognostic utility of multimodality cardiac imaging in the assessment of cardiac amyloidosis.

Takotsubo cardiomyopathy in orthotopic liver transplant recipients: A cohort study using multi-center pooled electronic health record data

BACKGROUND Takotsubo cardiomyopathy(TCM),or stress-induced cardiomyopathy,is associated with adverse prognosis.Limited data suggest that TCM occurring in orthotopic liver transplant(OLT)recipients is associated with elevated perioperative risk.AIM To characterize the predictors of TCM in OLT recipients,using a large,multicenter pooled electronic health database.METHODS A multi-institutional database(Explorys Inc,Cleveland,OH,USA),an aggregate of de-identified electronic health record data from 26 United States healthcare systems was surveyed.A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of“liver transplant”between 09/2015 and 09/2020 was identified.Subsequently,individuals who developed a new diagnosis of TCM following OLT were identified.Furthermore,the risk associations with TCM among this patient population were characterized using linear regression.RESULTS Between 09/2015 and 09/2020,of 37718540 patients in the database,38740(0.10%)had a history of OLT(60.6%had an age between 18-65 years,58.1%female).A new diagnosis of TCM was identified in 0.3%of OLT recipients(45.5%had an age between 18-65 years,72.7%female),compared to 0.04%in non-OLT patients[odds ratio(OR):7.98,95%confidence intervals:6.62-9.63,(P<0.0001)].OLT recipients who developed TCM,compared to those who did not,were more likely to be greater than 65 years of age,Caucasian,and female(P<0.05).There was also a significant association with cardiac arrhythmias,especially ventricular arrhythmias(P<0.0001).CONCLUSION TCM was significantly more likely to occur in LT recipients vs non-recipients.Older age,Caucasian ethnicity,female gender,and presence of arrhythmias were significantly associated with TCM in LT recipients.