TY - JOUR
T1 - 18 F-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material
AU - Pizzi, María N.
AU - Dos-Subirà, L.
AU - Roque, Albert
AU - Fernández-Hidalgo, Nuria
AU - Cuéllar-Calabria, Hug
AU - Pijuan Domènech, Antonia
AU - Gonzàlez-Alujas, María T.
AU - Subirana-Domènech, M. T.
AU - Miranda-Barrio, B.
AU - Ferreira-González, Ignacio
AU - González-López, Juan J.
AU - Igual, Albert
AU - Maisterra-Santos, Olga
AU - García-Dorado, David
AU - Castell-Conesa, Joan
AU - Almirante, Benito
AU - Escobar Amores, Manuel
AU - Tornos, Pilar
AU - Aguadé-Bruix, Santiago
PY - 2017/12/1
Y1 - 2017/12/1
N2 - © 2017 Elsevier Ireland Ltd Objectives Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of 18 F-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients’ complex anatomy. Methods A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (≥ 18 years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC + PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. Results Between November-2012 and April-2017, 25 patients (15 men; median age 40 years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC + PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. Conclusions PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification.
AB - © 2017 Elsevier Ireland Ltd Objectives Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of 18 F-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients’ complex anatomy. Methods A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (≥ 18 years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC + PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. Results Between November-2012 and April-2017, 25 patients (15 men; median age 40 years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC + PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. Conclusions PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification.
KW - 18 F-FDG-PET/CT
KW - Adult
KW - Cardiac computed tomography
KW - Congenital cardiac disease
KW - Infective endocarditis
KW - Prosthetic material
U2 - 10.1016/j.ijcard.2017.08.008
DO - 10.1016/j.ijcard.2017.08.008
M3 - Article
SN - 0167-5273
VL - 248
SP - 396
EP - 402
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -