The “3M” Approach to Cardiovascular Infections: Multimodality, Multitracers, and Multidisciplinary

Abstract

Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management, as early treatment improves the prognosis. The diagnosis cannot be made on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. In this review, we describe data supporting the use of a Multimodality, Multitracer, and Multidisciplinary approach (the 3M approach) to cardiovascular infections. In particular, the role of white blood cell SPECT/CT and [F]FDG PET/CT in most prevalent and clinically relevant cardiovascular infections will be discussed. In addition, the needs of advanced hybrid equipment, dedicated imaging acquisition protocols, specific expertise for image reading, and interpretation in this field are discussed, emphasizing the need for a specific reference framework within a Cardiovascular Multidisciplinary Team Approach to select the best test or combination of tests for each specific clinical situation.

Detection of Device Infection Using Nuclear Cardiology Imaging

“…4 No. 1 52-59 low resolution have been overcome to a large extent during the last decade by the introduction of hybrid imaging (1,4,6).…”

“…The "3M" approach (i.e. multimodality, multi-tracers and multisciplinary) has been recently proposed in CVSDI to integrate the traditional diagnostic criteria (1). A multidisciplinary team to discuss laboratory results, multimodality imaging findings and patients' management has been successfully introduced for the optimal management of cardiovascular infections, resulting in a lower in-hospital and 1-and 3-year mortality reduction across Europe (7)(8)(9)(10)(11)(12).…”

“…Within this Team, the role of the imager has grown, giving the importance of his/her active contribution in the clinical decision making process. Deep knowledge and expertise of both the technical and clinical aspects of multimodalities imaging in cardiovascular infections are more and more important for an active and successful contribution (1,3). Ecocardiography was negative.…”

“…CVSDI are of increasing concern. The severity of the infection depends upon the type of pathogen, the biofilm's characteristics, the type and the location of the biomaterial, and the host defense status (1,2). The diagnosis is extremely challenging due to an extremely heterogeneous clinical picture characterized by aspecific signs and symptoms.…”

“…The diagnosis relies on careful patient' s assessment according to specific diagnostic flow-chart. A multidisciplinary approach is necessary and has been shown reducing mortality (1,(3)(4)(5). Strategies to facilitate early diagnosis are crucial for a favorable clinical outcome.…”