Comparison Between ESC and Duke Criteria for the Diagnosis of Prosthetic Valve Infective Endocarditis

Abstract

Background:18 F-FDG PET/CT has been added as a major criterion in the ESC 2015 infective endocarditis guidelines, but the benefit of the ESC criteria has not been prospectively compared with the conventional Duke criteria Objectives:1. Primary objective: To assess the value of the ESC criteria including 18 F-FDG-PET/CT in prosthetic valve infective endocarditis (PVE). 2. Secondary objectives i: to assess the reproducibility of 18 F-FDG-PET/CT, ii: to compare its diagnostic value with that of echocardiography, and iii: to assess the diagnostic value of the presence of a diffuse splenic uptake Methods :Between 2014 and 2017, 175 patients with suspected PVE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable 18 F-FDG PET/CT, 115 patients were evaluated, including 91 definite and 24 rejected IE, as defined by an expert Consensus. Results :Cardiac uptake by 18 F-FDG PET/CT was observed in 67/91 patients with definite PVE and 6 with rejected IE (sensitivity 73.6% 95%CI: 63.3 to 82.3%, specificity 75% 53.3% to 90.2%). The ESC 2015 classification increased the sensitivity of Duke criteria from 57.1% 46.3 to 67.5% to 83.5% 74.3% to 90.5%, (p< 0.001) but decreased its specificity from 95.8%  78.9% to 99.9% to 70.8% 48.9% to 87.4%. Intraobserver reproducibility of 18 F-FDG PET/CT was good (kappa= 0.84) but inter observer reproducibility was less satisfactory (kappa= 0.63). A diffuse splenic uptake was observed in 24 (20.3%) patients, including 23 (25.3%) of definite PVE, and only 1 (4.2%) rejected PVE (p=0.024). Conclusion :18 F-FDG PET/CT is a useful diagnostic tool in suspected PVE, and explains the greater sensitivity of ESC criteria compared to Duke criteria. However, 18 F-FDG PET/CT also presents important limitations concerning its feasibility, specificity and reproducibility. Our study describes for the first time a new endocarditis criterion, i.e. the presence of a diffuse splenic uptake on 18 F-FDG PET/CT.

Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review

“…As a result, Saby et al [ 60 ] reported an improvement of the modified Duke criteria sensitivity from 70% to 97% without trading-off its specificity, with the use of PET/CT [ 60 ]. Although similar findings in terms of sensitivity were found by Philip et al [ 61 ] in 115 patients with PVE (91 definite cases and 24 rejected cases) where the sensitivity increased from 57.1% to 83.5%; there was a decrease in specificity from 95.8% to 70.8%, with an overall improvement in accuracy from 65.2% to 80.9%. Wang et al [ 62 ] also reported in 333 patients with PVE an enhanced sensitivity of 86%, however, the sensitivity of the test decreased to 72% in the presence of cardiac implantable electronic devices (CIED)[ 62 ].…”

Diagnostic value of the modified Duke criteria in suspected infective endocarditis —The PRO-ENDOCARDITIS study

“…With advances in multi-modality imaging, diagnostic approaches are currently adapting and will further improve imaging technologies and new applications. For instance, a recent prospective evaluation from three French centers found that 18 F-FDG-positron emission tomography combined with computed tomography may be a useful tool in suspected IE, improving the sensitivity of diagnostic algorithms (Philip et al, 2020). In our observational study, positron emission tomography was performed in 18% of patients and improved the model's accuracy.…”

Integration of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in diagnostic algorithm of prosthetic valve endocarditis: A case report and review of literature

“…[ 12 ] A detailed overview of available literature pertaining to the role of 18 F-FDG PET-CT in PVE is presented in Table 1 . [ 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] A recent meta-analysis by Wang et al . [ 30 ] showed a pooled sensitivity of 80.5% (95% confidence interval [CI] 74.1%–86.0%) and specificity of 73.1% (95% CI 63.8–81.2%) in PVE.…”