From the Research
When evaluating MR secondary to infective endocarditis, you would expect to see increased E-wave velocity with a shortened deceleration time, reflecting elevated left atrial pressure from the regurgitant volume, as well as a high E/A ratio indicating restrictive filling, based on the most recent evidence from 2024 1.
Expected Findings on Pulse-Wave Doppler Spectrum
The expected findings on a pulse-wave Doppler spectrum of the mitral inflow with the sample volume placed at the leaflet tips in a patient with MR secondary to infective endocarditis include:
- Increased E-wave velocity
- Shortened deceleration time
- High E/A ratio, typically greater than 2, indicating restrictive filling
- Dense spectral broadening of the Doppler signal due to turbulent flow caused by vegetations or damaged valve leaflets
- Potential holodiastolic flow reversal in the pulmonary veins if the MR is severe These findings are a result of the valve destruction caused by infective endocarditis, leading to abnormal blood flow patterns, as described in a case report from 2024 1.
Complementary Findings
Complementary findings that may be observed include:
- Color Doppler evidence of regurgitant jets
- Potential visualization of vegetations on 2D imaging The severity of these Doppler abnormalities generally correlates with the degree of valvular damage and regurgitation severity, as discussed in a review of diagnostic imaging in infective endocarditis from 2020 2.
Multimodality Imaging Approach
A multimodality imaging approach, including transthoracic and transesophageal echocardiography, as well as other imaging modalities such as multidetector computed tomography and nuclear imaging techniques, may be necessary to evaluate and manage infective endocarditis, as described in a review from 2020 3.