18F-FDG PET/CT improves diagnostic certainty in native and prosthetic valve Infective Endocarditis over the modified Duke Criteria.
J Nucl Cardiol
; 29(5): 2119-2128, 2022 Oct.
Article
in En
| MEDLINE
| ID: mdl-34169473
ABSTRACT
BACKGROUND:
International guidance recognizes the shortcomings of the modified Duke Criteria (mDC) in diagnosing infective endocarditis (IE) when transoesophageal echocardiography (TOE) is equivocal. 18F-FDG PET/CT (PET) has proven benefit in prosthetic valve endocarditis (PVE), but is restricted to extracardiac manifestations in native disease (NVE). We investigated the incremental benefit of PET over the mDC in NVE.METHODS:
Dual-center retrospective study (2010-2018) of patients undergoing myocardial suppression PET for NVE and PVE. Cases were classified by mDC pre- and post-PET, and evaluated against discharge diagnosis. Receiver Operating Characteristic (ROC) analysis and net reclassification index (NRI) assessed diagnostic performance. Valve standardized uptake value (SUV) was recorded.RESULTS:
69/88 PET studies were evaluated across 668 patients. At discharge, 20/32 had confirmed NVE, 22/37 PVE, and 19/69 patients required surgery. PET accurately re-classified patients from possible, to definite or rejected (NRI NVE 0.89; PVE 0.90), with significant incremental benefit in both NVE (AUC 0.883 vs 0.750) and PVE (0.877 vs 0.633). Sensitivity and specificity were 75% and 92% in NVE; 87% and 86% in PVE. Duration of antibiotics and C-reactive Protein level did not impact performance. No diagnostic SUV cut-off was identified.CONCLUSION:
PET improves diagnostic certainty when combined with mDC in NVE and PVE.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Heart Valve Prosthesis
/
Prosthesis-Related Infections
/
Endocarditis
/
Endocarditis, Bacterial
Type of study:
Diagnostic_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
J Nucl Cardiol
Journal subject:
CARDIOLOGIA
Year:
2022
Document type:
Article
Affiliation country:
United kingdom