title: Are novel non-invasive imaging techniques needed in patients with suspected prosthetic heart valve endocarditis? A systematic review and meta-analysis.
abstract: OBJECTIVE
  Multimodal non-invasive imaging plays a key role in establishing a diagnosis of PHV endocarditis. The objective of this study was to provide a systematic review of the literature and meta-analysis of the diagnostic accuracy of TTE, TEE, and MDCT in patients with (suspected) PHV endocarditis.
  
  
  METHODS
  Studies published between 1985 and 2013 were identified via search and cross-reference of PubMed/Embase databases. Studies were included if (1) they reported on the non-invasive index tests TTE, TEE, or MDCT; (2) data was provided on PHV endocarditis as the condition of interest; and (3) imaging results were verified against either surgical inspection/autopsy or clinical follow-up reference standards, thereby enabling the extraction of 2-by-2 tables.
  
  
  RESULTS
  Twenty articles (including 496 patients) met the inclusion criteria for PHV endocarditis. TTE, TEE, and MDCT + TEE had a pooled sensitivity/specificity for vegetations of 29/100%; 82/95%, and 88/94%, respectively. The pooled sensitivity/specificity of TTE, TEE, and MDCT + TEE for periannular complications was 36/93%, 86/98%, and 100/94%, respectively.
  
  
  CONCLUSIONS
  TEE showed good sensitivity and specificity for establishing a diagnosis of PHV endocarditis. Although MDCT data are limited, this review showed that MDCT in addition to TEE may improve sensitivity in detecting life-threatening periannular complications.
  
  
  CONCLUSIONS
  • Multimodal imaging is an important ingredient of diagnostic workup for PHV endocarditis. • Transthoracic and transesophageal echography may miss life-threatening periannular complications. • MDCT can improve sensitivity for the detection of life-threatening periannular complications.
authors: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands, J.Habets@umcutrecht.nl.
authors: Jesse
authors: J
authors: Habets
authors: Wilco
authors: W
authors: Tanis
authors: Johannes B
authors: JB
authors: Reitsma
authors: Renee B A
authors: RB
authors: van den Brink
authors: Willem P Th M
authors: WP
authors: Mali
authors: Steven A J
authors: SA
authors: Chamuleau
authors: Ricardo P J
authors: RP
authors: Budde
mesh_terms: D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D004696:Endocarditis / Q000175:diagnosis*; D006350:Heart Valve Prosthesis; D006801:Humans; D061330:Multidetector Computed Tomography / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity