Tom Kai Ming Wang1,2, Mnahi Bin Saeedan2, Nicholas Chan1, Nancy A Obuchowski2,3, Nabin Shrestha4, Bo Xu1,2, Shinya Unai5, Paul Cremer1,2, Richard A Grimm1,2, Brian P Griffin1, Scott D Flamm1, Gosta B Pettersson5, Zoran B Popovic1,2, Michael A Bolen1,2. 1. Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (T.K.M.W., N.C., B.X., P.C., R.A.G., B.P.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH. 2. Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., M.B.S., N.A.O., B.X., P.C., R.A.G., S.D.F., Z.B.P., M.A.B.), Cleveland Clinic, OH. 3. Department of Quantitative Health Sciences (N.A.O.), Cleveland Clinic, OH. 4. Department of Infectious Disease, Respiratory Institute (N.S.), Cleveland Clinic, OH. 5. Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute (S.U, G.B.P.), Cleveland Clinic, OH.
Abstract
BACKGROUND: Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery. METHODS: Of 833 consecutive patients with surgically proven IE during May 1, 2014 to May 1, 2019, at Cleveland Clinic, 155 underwent both preoperative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II (European System for Cardiac operative Risk Evaluation II). RESULTS: CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients, respectively. Thirty-day mortality occurred in 3 (1.9%) patients and composite mortality or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality or morbidities in-hospital, with odds ratio (95% CI) of 3.66 (1.76-7.59), P=0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95% CI) of 3.82 (1.25-11.7), P<0.001 and 9.84 (1.89-51.0), P=0.007, respectively. CONCLUSIONS: We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.
BACKGROUND: Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery. METHODS: Of 833 consecutive patients with surgically proven IE during May 1, 2014 to May 1, 2019, at Cleveland Clinic, 155 underwent both preoperative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II (European System for Cardiac operative Risk Evaluation II). RESULTS: CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients, respectively. Thirty-day mortality occurred in 3 (1.9%) patients and composite mortality or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality or morbidities in-hospital, with odds ratio (95% CI) of 3.66 (1.76-7.59), P=0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95% CI) of 3.82 (1.25-11.7), P<0.001 and 9.84 (1.89-51.0), P=0.007, respectively. CONCLUSIONS: We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.
Authors: Juan C Lopez-Mattei; Eric H Yang; Maros Ferencik; Lauren A Baldassarre; Susan Dent; Matthew J Budoff Journal: JACC CardioOncol Date: 2021-12-21