Barbieri Andrea, Cecchi Enrico, Bursi Francesca, Mantovani Francesca
Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, 41122 Modena, Italy.
Department of Cardiology, Humanitas Cellini, 10100 Turin, Italy.
Rev Cardiovasc Med. 2023 Oct 8;24(10):283. doi: 10.31083/j.rcm2410283. eCollection 2023 Oct.
Despite significant advances in understanding and outcomes in various domains of cardiology, the prognosis of infective endocarditis (IE) remains dismal. One of the main reasons may rely on an even more intricate diagnosis since epidemiology has shifted towards an aggressive infection, typically in older patients with the involvement of prosthetic valves and cardiovascular implantable electronic devices with earlier clinical presentation. In this novel setting, it is critical to avoid a delay in diagnosis that may delay subsequent adequate treatment, further complications, and ultimately poor clinical outcomes. Accordingly, based on the available data, we will examine the proper use of first-line echocardiography representing the first-line imaging method in patients with clinical suspicion of IE. We will focus on the following three crucial questions: (1) What is the threshold to start the echocardiographic diagnostic workup in stable patients? (2) Has infective endocarditis become a time-dependent diagnosis, even in stable patients? (3) What is the appropriate use of echocardiography in unstable patients? Finally, we propose a new mindset to improve the echocardiographic diagnostic workflow.
尽管在心脏病学各个领域的认识和治疗结果方面取得了重大进展，但感染性心内膜炎（IE）的预后仍然不容乐观。其中一个主要原因可能在于诊断变得更加复杂，因为流行病学已转向侵袭性感染，通常发生在老年患者中，涉及人工瓣膜和心血管植入式电子设备，且临床表现出现得更早。在这种新情况下，避免诊断延迟至关重要，因为诊断延迟可能会延误后续的充分治疗、引发更多并发症，并最终导致不良的临床结局。因此，基于现有数据，我们将探讨如何正确使用一线超声心动图，它是临床怀疑患有IE患者的一线成像方法。我们将关注以下三个关键问题：（1）在病情稳定的患者中，启动超声心动图诊断检查的阈值是多少？（2）即使在病情稳定的患者中，感染性心内膜炎是否已成为一种与时间相关的诊断？（3）在病情不稳定的患者中，超声心动图的恰当应用是什么？最后，我们提出一种新的思维方式，以改进超声心动图诊断流程。
