From the Guidelines
Doppler echocardiography findings associated with endocarditis include regurgitant jets across heart valves, vegetations on valves causing valvular stenosis, paravalvular leaks, and perforations in valve leaflets, which can be detected using various Doppler modes, such as color Doppler, continuous wave Doppler, and pulsed wave Doppler 1.
Key Findings
- Regurgitant jets across heart valves, indicating valve insufficiency
- Vegetations on valves, causing valvular stenosis, detected as increased flow velocity across the affected valve
- Paravalvular leaks, appearing as abnormal flow around valve prostheses rather than through them, indicating dehiscence of the valve from the annulus
- Perforations in valve leaflets, visualized as abnormal jets through the valve tissue itself
Diagnostic Approach
The diagnostic approach for endocarditis involves the use of echocardiography, particularly transesophageal echocardiography (TEE), which has a higher sensitivity than transthoracic echocardiography (TTE) for detecting prosthetic valve vegetations, prosthetic valve abscesses, and lead infections 1.
Importance of Early Detection
Early detection of these abnormalities is crucial for diagnosis and management of endocarditis, as they reflect the hemodynamic consequences of the infection, and can guide prognosis and treatment decisions, including the need for surgical intervention 1.
From the Research
Doppler Ultrasound Findings in Infective Endocarditis
- Doppler ultrasound findings associated with infective endocarditis include the detection of valvular vegetations, valvular destruction, and secondary complications such as severe regurgitation, paravalvular abscesses, and embolic events 2
- The size and mobility of vegetations can stratify endocarditis patients into a high-risk group for arterial embolism, with larger vegetations (>10 mm) associated with increased risk 3, 2
- Doppler ultrasound can also assess the degree of valve insufficiency and its hemodynamic significance, which can be useful in evaluating the severity of infective endocarditis 4
- Transesophageal echocardiography (TEE) has been shown to be highly sensitive (above 90%) for the detection of valvular vegetations and is particularly useful in patients with suspected endocarditis but a negative transthoracic echocardiogram 2
- TEE can also detect paravalvular abscesses and other complications, which can have important implications for patient management and prognosis 3, 2
Prognostic Implications of Doppler Ultrasound Findings
- The presence of large vegetations (>10 mm) has been associated with increased mortality and complications, including embolic events, valve rupture, and heart failure 3, 5
- However, surgery may not be associated with a better prognosis in patients with large vegetations if they do not present with another predictor of poor outcome, such as heart failure or uncontrolled infection 5
- Significant valve regurgitation is common in patients surviving native valve infective endocarditis and is associated with an increased risk of heart failure, highlighting the importance of close monitoring and timely surgical intervention 6