Impact of Systematic Whole-body 18F-Fluorodeoxyglucose PET/CT on the Management of Patients Suspected of Infective Endocarditis: The Prospective Multicenter TEPvENDO Study

Abstract

Background Diagnostic and patients’ management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients. Methods 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients’ management plan were established jointly by two experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients’ management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established. Results Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (p<0.001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (p=0.005) (net reclassification index 20% and 4.3%). Patients’ managements were modified in 21.4% PV and 31.4% NV patients (p=0.25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% CI: 32-48), which was most likely to occur in those with a non-contributing echocardiography (p<0.001) or IE classified as possible at baseline (p=0.04), while there was no difference between NV and PV. Conclusions Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients.

Recurrent culture-negative endocarditis and osteomyelitis caused by Q fever in Iran, a case report

“…To identify extra cardiac IE manifestations, classi cation, and also management, PET/CT scan is helpful. In our patient all the studies except PET/CT scan couldn't reveal the IE evidence, therefore we should declare that performing PET/CT scan is a necessary evaluation in IE cases or even in those with suspicious IE diagnosis [27,28].…”

Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies

“…Further, results of blood cultures can be inconclusive due to contamination by commensal bacteria, a complex polymicrobial biofilm (Oberbach et al, 2017), or insufficient amounts of bacteria to culture. Negative blood cultures are found in approximately 24% of all IE cases, which is similar for NVE (25%), CDRIE (26%), and PVE (23%) (Hussein et al, 2016;Koneru et al, 2018;Calais et al, 2019;de Camargo et al, 2019;El Gabry et al, 2019;Habib et al, 2019;Heriot et al, 2019;Nesterovics et al, 2019;Płońska-Gościniak et al, 2019;San et al, 2019;Witten et al, 2019;Bohbot et al, 2021;Duval et al, 2021;Jędrzejczyk-Patej et al, 2021;Michałowska et al, 2021;Pyo et al, 2021).…”

“…Microorganism prevalence was evaluated based on all IE, NVE, CDRIE, PVE ( Figure 2 ). Staphylococcus aureus accounts for 27% of NVE, followed by streptococci (26%), and enterococci (12%) ( de Camargo et al, 2019 ; El Gabry et al, 2019 ; Habib et al, 2019 ; Heriot et al, 2019 ; San et al, 2019 ; Chambers and Bayer, 2020 ; Hubers et al, 2020 ; Bohbot et al, 2021 ; Duval et al, 2021 ; Pyo et al, 2021 ). Coagulase-negative staphylococci have a prevalence of 6.3% in NVE, which is in contrast to CDRIE with 25.2% ( Hussein et al, 2016 ; Koneru et al, 2018 ; Calais et al, 2019 ; Habib et al, 2019 ; Nesterovics et al, 2019 ; San et al, 2019 ; Witten et al, 2019 ; Bohbot et al, 2021 ; Duval et al, 2021 ; Pyo et al, 2021 ).…”

“…Staphylococcus aureus accounts for 27% of NVE, followed by streptococci (26%), and enterococci (12%) ( de Camargo et al, 2019 ; El Gabry et al, 2019 ; Habib et al, 2019 ; Heriot et al, 2019 ; San et al, 2019 ; Chambers and Bayer, 2020 ; Hubers et al, 2020 ; Bohbot et al, 2021 ; Duval et al, 2021 ; Pyo et al, 2021 ). Coagulase-negative staphylococci have a prevalence of 6.3% in NVE, which is in contrast to CDRIE with 25.2% ( Hussein et al, 2016 ; Koneru et al, 2018 ; Calais et al, 2019 ; Habib et al, 2019 ; Nesterovics et al, 2019 ; San et al, 2019 ; Witten et al, 2019 ; Bohbot et al, 2021 ; Duval et al, 2021 ; Pyo et al, 2021 ). Microorganisms obtained from cultures of CDRIE patients were predominately staphylococci (54%), followed by streptococci (12%) and enterococci (5%) ( Habib et al, 2015 ; Hussein et al, 2016 ; Koneru et al, 2018 ; Calais et al, 2019 ; Nesterovics et al, 2019 ; Płońska-Gościniak et al, 2019 ; Witten et al, 2019 ; Jędrzejczyk-Patej et al, 2021 ).…”

Infective Endocarditis: New Challenges in a Classic Disease

“…The role of FDG-PET/CT in the diagnosis of native-valve endocarditis might be restricted to situations when there is a high suspicion but not enough evidence to fulfill Duke criteria. Additionally, FDG-PET/CT has diagnostic utility in detecting unexpected sources of primary infections and extracardiac complications of endocarditis, [48][49][50][51] with significant impact on patient management 52 (►Fig. 12).…”