Impact of nuclear imaging on diagnosis and management of infective endocarditis

Background: Embolisation and metastatic infection occur frequently in infective endocarditis (IE). We aimed to evaluate the impact of nuclear imaging on diagnosis, therapy and mortality. Methods: All patients hospitalised for definite IE at the University Hospitals of Leuven in 2001 and in 2015 were retrospectively included. Demographic, clinical, diagnostic and outcome data were analysed by univariate statistical analysis. Results: Data of 122 patients were analysed. Demographic parameters of 61 patients hospitalised in 2015 compared with 61 patients hospitalised in 2001 showed no significant differences. More fundoscopic examinations (p = .002) and more nuclear imaging (p < .001) were performed in 2015. This did not result in a higher detection of retinal embolisms (p = .543). However, more episodes of symptomatic embolisation and metastatic infection (p = .002) and more occult systemic complications (p = .014) were found. In particular, spondylodiscitis was more frequently diagnosed in 2015 (p = .013). The amount of cardiac surgery and the in-hospital mortality did not differ between the two years (p = .131 and p = .810). After exclusion of patients presenting in heart failure who needed emergent surgery, the overall time to surgery was significantly shorter in 2015 (p = .043). Conclusion: The use of nuclear imaging was increased in 2015 compared to 2001. This led to more diagnoses of embolisation and metastatic infections that were not clinically evident. In patients not presenting in a critical clinical state, cardiac surgery was performed earlier in 2015. However, the in-hospital mortality was not affected.