Improving Preoperative Abscess Detection in Infective Endocarditis by Adding High-Sensitivity Troponin I to Transesophageal Echocardiography—A REMOVE Trial Analysis

Background: Detection of cardiac abscess in patients with infective endocarditis (IE) is important for surgical planning but diagnostic accuracy of transesophageal echocardiography (TEE) is limited. Since abscesses often affect cardiac muscle, high-sensitivity cardiac Troponin (h-s cTn) may help in abscess detection. We aim to assess the value of h-s cTn added to TEE for preoperative diagnosis of cardiac abscess.

Method: Data for patients included in the prospective, multicenter, randomized, controlled trial (REMOVE-Trial) were analyzed. The diagnostic performance of TEE was evaluated by comparing TEE findings with intraoperative findings. The diagnostic performance of h-s cTn was assessed by Receiver operating characteristic (ROC) curve.

Results: In the 282 patients included, 84 abscesses were confirmed intraoperatively. The sensitivity and specificity of preoperative TEE to detect abscesses were 58.3 and 86.4%, respectively. Either cTnI or cTnT was measured within 24 hours before surgery (n = 113 and 90, respectively). cTnI was 5.8-fold the upper reference level (URL) in patients with abscess and 1.8-fold URL in those without (p = 0.001). cTnT was 76.2-fold URL in patients with abscess and 49.8-fold URL in those without (p = 0.353). The area under the curves (AUCs) for cTnI and cTnT were 0.689 and 0.560, respectively. The AUCs for the TEE + cTnI or cTnT were 0.835 (95% CI: 0.75–0.91, p < 0.001) and 0.634 (95% CI: 0.50–00.77, p = 0.068), respectively.

Conclusion: The results suggest that using TEE alone is a suboptimal method for abscess detection in IE. Adding preoperative h-s troponin I but not h-s troponin T-values to TEE findings improved IE abscess detection.

Publication History

Article published online:
28 January 2023