Whole-body computed tomography's role in redefining left-sided infective endocarditis diagnosis and management

BACKGROUND: Septic embolism, heart failure, perivalvular involvement, and uncontrolled infection are common complications of infective endocarditis (IE) and frequent indications for surgery. AIMS: We evaluated the impact of introducing whole‑body computed tomography (WB‑CT; brain, chest, abdomen) into the diagnostic work-up of patients with left‑sided IE (LS-IE) on detection of embolic and perivalvular complications and on surgical indications. METHODS: We retrospectively analyzed 366 patients admitted with LS-IE from 2015 to 2024. Patients were classified according to whether WB-CT was performed during hospitalization. RESULTS: Of 366 patients, 132 (36.1%) underwent WB‑CT. Mean age was 57.9 (15.7) years, 79.8% were men, and surgery was performed in 268 patients (73.2%). Among patients who underwent WB-CT, embolic complications occurred in the spleen in 56 (42.4%), the brain in 28 (21.2%), and other sites in 23 (17.4%). The WB-CT strategy detected extracardiac embolic complications more often than the non-WB-CT protocol at each site (P <0.001). Perivalvular pseudoaneurysms were identified more frequently on CT than on echocardiography (P = 0.008). Among operated patients with WB‑CT (n = 94; 35.1%), embolism prevention was the main indication (47.9% vs. 23.0%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.80-5.26; P <0.001). By contrast, heart failure predominated in the non-WB-CT group (47.1% vs. 19.1%; OR, 0.26; 95% CI, 0.15-0.48; P <0.001). CONCLUSIONS: WB-CT was associated with a higher detection of embolic and perivalvular complications in LS-IE and with a different pattern of surgical indications, with embolism prevention more frequent in the WB-CT group.