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Pisani AR, Rubini D, Altini C, Ruta R, Gazzilli M, Sardaro A, Iuele F, Maggialetti N, Rubini G. The Role of the 18F-FDG PET/CT in the Management of Patients Suspected of Cardiac Implantable Electronic Devices' Infection. J Pers Med 2024; 14:65. [PMID: 38248766 PMCID: PMC10820973 DOI: 10.3390/jpm14010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Infection of Cardiac Implantable Electronic Devices (CIEDI) is a real public health problem. The main aim of this study was to determine the diagnostic performance of 18F-FDG PET/CT in the diagnosis of CIEDI. Methods: A total of 48 patients, who performed 18F-FDG PET/CT for the clinical suspicion of CIEDI were retrospectively analyzed; all patients were provided with a model with procedural recommendations before the exam. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of 18F-FDG PET/CT were calculated; the reproducibility of qualitative analysis was assessed with Cohen's κ test. The semi-quantitative parameters (SUVmax, SQR and TBR) were evaluated in CIEDI+ and CIEDI- patients using the Student' t-test; ROC curves were elaborated to detect cut-off values. The trend of image quality with regards to procedural recommendation adherence was evaluated. Results: Se, Sp, PPV, NPV and DA were respectively 96.2%, 81.8%, 86.2%, 94.7% and 89.6%. The reproducibility of qualitative analysis was excellent (K = 0.89). Semiquantitative parameters resulted statistically different in CIEDI+ and CIEDI- patients. Cut-off values were SUVmax = 2.625, SQR = 3.766 and TBR = 1.29. Trend curves showed increasing image quality due to adherence to procedural recommendations. Conclusions:18F-FDG-PET/CT is a valid tool in the management of patients suspected of CIEDI and adherence to procedural recommendations improves its image quality.
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Affiliation(s)
- Antonio Rosario Pisani
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Dino Rubini
- Radiotherapy, Precision Medicine Department, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Corinna Altini
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Rossella Ruta
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesca Iuele
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Maggialetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Rubini
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Sordelli C, Weisz SH, Fele N, Verde R, Guarino A, Perrella A, Severino L, Severino C, Severino S. Three-dimensional Transesophageal Echocardiography in Infective Endocarditis: What Does It Add? J Cardiovasc Echogr 2024; 34:1-6. [PMID: 38818319 PMCID: PMC11135816 DOI: 10.4103/jcecho.jcecho_80_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 06/01/2024] Open
Abstract
Infective endocarditis (IE) diagnosis is based on a clinical suspicion supported by consistent microbiological and instrumental data. Evidence of involvement of cardiac valves (native or prosthetic) or prosthetic intracardiac material is a major diagnostic criterion of IE. Transthoracic echocardiography (TTE) is the initial technique of choice for the diagnosis while transesophageal echocardiography (TEE) is recommended in patients with an inconclusive or negative TTE, in patients with high suspicion of IE, as well as in patients with a positive TTE, in order to document local complications. Repeating TTE and/or TEE should be considered during follow-up of uncomplicated IE, in order to detect new silent complications and monitor vegetation size. In the setting of IE, the role of three-dimensional (3D) TEE is increasing; in fact, this technique has also been shown to be useful for the diagnosis of IE and its complications as it allows to obtain infinite planes and volumetric reconstructions. In this review, we will describe the usefulness of 3D-TEE and its added value in the management of IE.
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Affiliation(s)
- Chiara Sordelli
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
| | - Sara Hana Weisz
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
| | - Nunzia Fele
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
| | - Raffaele Verde
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
| | - Angela Guarino
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
| | | | - Laura Severino
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
| | - Corrado Severino
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
| | - Sergio Severino
- Infectious Cardiology Disease Unit, Ospedale Cotugno, Naples, Italy
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Babes EE, Bustea C, Ilias TI, Babes VV, Luca SA, Luca CT, Radu AF, Tarce AG, Bungau AF, Bustea C. Multimodality Imaging Diagnosis in Infective Endocarditis. Life (Basel) 2023; 14:54. [PMID: 38255669 PMCID: PMC10821102 DOI: 10.3390/life14010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.
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Affiliation(s)
- Elena Emilia Babes
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Tiberia Ioana Ilias
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Victor Vlad Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Silvia-Ana Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Constantin Tudor Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alexandra Georgiana Tarce
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Alexa Florina Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
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Hernández-Meneses M, Perissinotti A, Páez-Martínez S, Llopis J, Dahl A, Sandoval E, Falces C, Ambrosioni J, Vidal B, Marco F, Cuervo G, Moreno A, Bosch J, Tolosana JM, Fuster D, Miró JM. Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:970-979. [PMID: 37028797 DOI: 10.1016/j.rec.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES The role of [18F]FDG-PET/CT in cardiac implantable electronic device (CIED) infections requires better evaluation, especially in the diagnosis of systemic infections. We aimed to determine the following: a) the diagnostic accuracy of [18F]FDG-PET/CT in each CIED topographical region, b) the added value of [18F]FDG-PET/CT over transesophageal echocardiography (TEE) in diagnosing systemic infections, c) spleen and bone marrow uptake in differentiating isolated local infections from systemic infections, and d) the potential application of [18F]FDG-PET/CT in follow-up. METHODS Retrospective single-center study including 54 cases and 54 controls from 2014 to 2021. The Primary endpoint was the diagnostic yield of [18F]FDG-PET/CT in each topographical CIED region. Secondary analyses described the performance of [18F]FDG-PET/CT compared with that of TEE in systemic infections, bone marrow and spleen uptake in systemic and isolated local infections, and the potential application of [18F]FDG-PET/CT in guiding cessation of chronic antibiotic suppression when completed device removal is not performed. RESULTS We analyzed 13 (24%) isolated local infections and 41 (76%) systemic infections. Overall, the specificity of [18F]FDG-PET/CT was 100% and sensitivity 85% (79% pocket, 57% subcutaneous lead, 22% endovascular lead, 10% intracardiac lead). When combined with TEE, [18F]FDG-PET/CT increased definite diagnosis o fsystemic infections from 34% to 56% (P=.04). Systemic infections with bacteremia showed higher spleen (P=.05) and bone marrow metabolism (P=.04) than local infections. Thirteen patients without complete device removal underwent a follow-up [18F]FDG-PET/CT, with no relapses after discontinuation of chronic antibiotic suppression in 6 cases with negative follow-up [18F]FDG-PET/CT. CONCLUSIONS The sensitivity of [18F]FDG-PET/CT for evaluating CIED infections was high in local infections but much lower in systemic infections. However, accuracy increased when [18F]FDG-PET/CT was combined with TEE in endovascular lead bacteremic infection. Spleen and bone marrow hypermetabolism could differentiate bacteremic systemic infection from local infection. Although further prospective studies are needed, follow-up [18F]FDG-PET/CT could play a potential role in the management of chronic antibiotic suppression therapy when complete device removal is unachievable.
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Affiliation(s)
- Marta Hernández-Meneses
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Servicio de Medicina Nuclear, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain
| | - Silvia Páez-Martínez
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Departamento de Genética, microbiología y estadística, Universidad de Barcelona, Barcelona, Spain
| | - Anders Dahl
- Department of Cardiology, Herlev-Gentofte University Hospital Copenhagen, Hellerup, Denmark
| | - Elena Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Carlos Falces
- Servicio de Cardiología, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain
| | - Bárbara Vidal
- Servicio de Cardiología, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Francesc Marco
- Servicio de Microbiología, Hospital Clinic-ISGlobal, Universidad de Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Servicio de Microbiología, Hospital Clinic-ISGlobal, Universidad de Barcelona, Barcelona, Spain
| | - José M Tolosana
- Servicio de Cardiología, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - David Fuster
- Servicio de Medicina Nuclear, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - José M Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain.
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5
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Chesdachai S, DeSimone DC, Baddour LM. Risk of Cardiac Implantable Electronic Device Infection in Patients with Bloodstream Infection: Microbiologic Effect in the Era of Positron Emission Tomography-Computed Tomography. Curr Cardiol Rep 2023; 25:781-793. [PMID: 37351825 DOI: 10.1007/s11886-023-01900-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE OF REVIEW Bloodstream infection (BSI) in patients with cardiac implantable electronic devices (CIEDs) is common and can prompt challenges in defining optimal management. We provide a contemporary narrative review of this topic and propose a pathogen-dependent clinical approach to patient management. RECENT FINDINGS BSI due to staphylococci, viridans group streptococci, and enterococci is associated with an increased risk of underlying CIED infection, while the risk of CIED infection due to other organisms is poorly defined. There is growing evidence that positron emission tomography-computed tomography may be helpful in some patients with BSI and underlying CIED. Twenty studies were included to examine the impact of microbiologic findings on the risk of CIED infection among patients with BSI. Diagnosis of CIED infection in patients with BSI without pocket findings is often difficult, necessitating the use of novel diagnostic tools to help guide the clinician in subsequent patient management.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
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Hernández-Meneses M, Perissinotti A, Vidal B, Tolosana JM, Miró JM. Diagnóstico clínico y por imagen de las infecciones de los dispositivos de estimulación cardiaca. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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7
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Holcman K, Rubiś P, Ćmiel B, Ząbek A, Boczar K, Szot W, Kalarus Z, Graczyk K, Hanarz M, Małecka B, Podolec P, Kostkiewicz M. To what extent does prior antimicrobial therapy affect the diagnostic performance of radiolabeled leukocyte scintigraphy in infective endocarditis? J Nucl Cardiol 2023; 30:343-353. [PMID: 35819715 DOI: 10.1007/s12350-022-03048-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS This prospective, single-center study sought to assess to what extent there is interference between the hybrid technique of single-photon emission tomography-computed tomography with technetium99m-hexamethylpropyleneamine oxime-labeled leukocytes (99mTc-HMPAO-SPECT/CT) and antimicrobial therapy in patients with infective endocarditis (IE). METHODS AND RESULTS During the years 2015-2019, we enrolled 205 consecutive adults with suspected IE, all underwent 99mTc-HMPAO-SPECT/CT. The study population was divided into those who had received antimicrobial therapy up to 30 days prior to 99mTc-HMPAO-SPECT/CT (group 1, n = 96) and those who had not (group 2, n = 109). Patients were prospectively observed for 12 ± 10 months. Group 1 presented higher positive predictive values (91.89% vs. 60.00%, = 0.001), and decreased negative predictive values (77.97% vs. 90.54%, P = 0.04). Patients treated with antimicrobial therapy displayed false-negative 99mTc-HMPAO-SPECT/CT results more often [odds ratio (OR), 4.63; 95% confidence interval (CI), 1.41-15.23, P = .01], particularly when intravenous (OR 5.37; 95% CI 1.73-16.62, P = .004), definite (OR 9.43; 95% CI 2.65-33.51, P = .001), and combination antibiotic regimens (OR 8.1; 95% CI 2.57-25.64, P = .001) had been administered. CONCLUSION Prior antibiotic therapy affects 99mTc-HMPAO-SPECT/CT diagnostic properties. Patients treated with antimicrobial therapy display false-negative 99mTc-HMPAO-SPECT/CT results more often, especially if intravenous, definite, or combination regimens are administered.
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Affiliation(s)
- Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland.
- Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland.
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Bogdan Ćmiel
- Faculty of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Boczar
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Wojciech Szot
- Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Zuzanna Kalarus
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Katarzyna Graczyk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Maksymilian Hanarz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Barbara Małecka
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, Krakow, Poland
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Sanghavi R, Ravikumar N, Sarodaya V, Haq M, Sherif M, Harky A. Outcomes in cardiac implantable electronic device-related infective endocarditis: a systematic review of current literature. Future Cardiol 2022; 18:891-899. [PMID: 36073290 DOI: 10.2217/fca-2021-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim: Cardiac implantable electronic device infective endocarditis is a serious infection with poor prognosis. Materials & methods: The systematic review of the literature was conducted using searches from the various databases. We included studies published between January 2010 and June 2021. Results: A total of 35 articles met the inclusion criteria. Patients were approximately 70 years old and an average of 71.2% of patients were male. The most common presenting feature was a fever. The modified Duke criteria was used to aid diagnosis. Management entailed extraction of the cardiac implantable electronic device in 80.5% of the studies. The overall mortality rates ranged from 4 to 36%. The most frequently isolated organism was Staphylococcus aureus. Conclusion: Cardiac implantable electronic device infective endocarditis needs timely diagnosis and effective management for promising outcomes.
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Affiliation(s)
- Ria Sanghavi
- Department of Medical Sciences, College of Life Sciences, University Of Leicester, Leicester, UK
| | - Nidhruv Ravikumar
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Varun Sarodaya
- Department of General Surgery, Junior Clinical fellow, Barts Health NHS Trust, London, UK
| | - Mawiyah Haq
- Faculty of Medicine, St George's University of London, London, UK
| | - Mohamed Sherif
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
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Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature. J Clin Med 2022; 11:jcm11195898. [PMID: 36233765 PMCID: PMC9570622 DOI: 10.3390/jcm11195898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022] Open
Abstract
The use of increasingly complex cardiac implantable electronic devices (CIEDs) has increased exponentially in recent years. One of the most serious complications in terms of mortality, morbidity and financial burden is represented by infections involving these devices. They may affect only the generator pocket or be generalised with lead-related endocarditis. Modifiable and non-modifiable risk factors have been identified and they can be associated with patient or procedure characteristics or with the type of CIED. Pocket and systemic infections require a precise evaluation and a specialised treatment which in most cases involves the removal of all the components of the device and a personalised antimicrobial therapy. CIED retention is usually limited to cases where infection is unlikely or is limited to the skin incision site. Optimal re-implantation timing depends on the type of infection and on the results of microbiological tests. Preventive strategies, in the end, include antibiotic prophylaxis before CIED implantation, the possibility to use antibacterial envelopes and the prevention of hematomas. The aim of this review is to investigate the pathogenesis, stratification, diagnostic tools and management of CIED infections.
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Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
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Jerónimo A, Olmos C, Vilacosta I, Ortega-Candil A, Rodríguez-Rey C, Pérez-Castejón MJ, Fernández-Pérez C, Pérez-García CN, García-Arribas D, Ferrera C, Carreras JL. Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections. J Nucl Cardiol 2022; 29:594-608. [PMID: 32748277 DOI: 10.1007/s12350-020-02285-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Utility of 18F-FDG PET/CT in diagnosing infective endocarditis (IE) associated with cardiac implantable electronic devices (CIEDs) is not well established. Current ESC guidelines recommend the use of FDG-PET imaging in patients with CIEDs and positive blood cultures, but the number of studies evaluating the diagnostic performance of FDG-PET imaging in these patients remain limited. Our objective was to assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, differentiating between pocket infection (PI) and lead infection (CIED-IE). METHODS AND RESULTS From 2013 to 2018, all patients (n = 63) admitted to a hospital with suspected CIED infection were prospectively recruited, undergoing a diagnostic work-up including a PET/CT. Explanted devices and material from the pocket were cultured. 14 cases corresponded to isolated PI and 13 were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, sensitivity and specificity of PET/CT for CIED-IE were 38.5% and 98.0%, respectively. Positive (19.2) and negative (0.6) likelihood ratio values, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis when negative. For PI, sensitivity and specificity were 72.2% and 95.6%, respectively. CONCLUSIONS The yield of 18F-FDG PET/CT for suspected CIED infections differs depending on the site of infection. Due to very high specificity but poor sensitivity, negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
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Affiliation(s)
- Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Aida Ortega-Candil
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Rodríguez-Rey
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - María Jesús Pérez-Castejón
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Fernández-Pérez
- Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Daniel García-Arribas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - José Luis Carreras
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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Salomäki SP, Saraste A, Kemppainen J, Hurme S, Knuuti J, Nuutila P, Seppänen M, Roivainen A, Airaksinen J, Salo T, Oksi J, Pirilä L, Hohenthal U. 18F-FDG positron emission tomography/computed tomography of cardiac implantable electronic device infections. J Nucl Cardiol 2021; 28:2992-3003. [PMID: 32737839 PMCID: PMC8709812 DOI: 10.1007/s12350-020-02256-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/18/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The diagnosis of cardiac implantable electronic device (CIED) infection is challenging because of its variable presentations. We studied the value of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the detection of CIED infection. METHODS AND RESULTS Thirty patients with suspected CIED infection underwent 18F-FDG-PET/CT. The control group was ten patients with asymptomatic CIED who underwent cancer-related 18F-FDG-PET/CT. 18F-FDG-PET/CT was evaluated visually, semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). Final diagnosis of CIED infection was based on clinical and bacteriological data. 18F-FDG-PET/CT was visually positive in all 9 patients with recent (≤ 8 weeks) implantation of CIED, but only 4 had confirmed CIED infection. 18F-FDG-PET/CT was true positive in 9 out of 21 cases with remote implantation of CIED and false positive in 3 (14.3%) cases. 18F-FDG-PET/CT was also false positive in 3 (30%) cases of control group. The SUVmax of the pocket area was significantly higher in patients with CIED infection than in the control group (4.8 ± 2.4 vs 2.0 ± .8, P < .001). By using the cut-off value of TBR ≥ 1.8, sensitivity of 18F-FDG-PET/CT for the diagnosis of CIED infection in patients with remote implantation was 90% and specificity 73%, PPV 75%, and NPV 89%. CONCLUSIONS 18F-FDG-PET/CT is a sensitive but nonspecific method in the diagnosis of CIED infection.
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Affiliation(s)
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Heart Centre, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Physiology and Nuclear Medicine, Turku University HospitalTurku University Hospital, Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Pirjo Nuutila
- Division of Medicine, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Marko Seppänen
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Physiology and Nuclear Medicine, Turku University HospitalTurku University Hospital, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Juhani Airaksinen
- Heart Centre, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tiina Salo
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Division of Medicine, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Laura Pirilä
- Division of Medicine, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Ulla Hohenthal
- Division of Medicine, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
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13
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Fava AM, Xu B. Tricuspid valve endocarditis: Cardiovascular imaging evaluation and management. World J Clin Cases 2021; 9:8974-8984. [PMID: 34786381 PMCID: PMC8567522 DOI: 10.12998/wjcc.v9.i30.8974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/23/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Right-sided infective endocarditis is an increasingly recognized disease entity, with tricuspid valve being most frequently involved. Risk factors for tricuspid valve endocarditis (TVIE) include intravenous drug use, cardiac implantable electronic devices and indwelling catheters. Staphylococcus aureus is the predominant causative organism in TVIE. The diagnosis of infective endocarditis (IE) is based on clinical manifestations, blood cultures, and the presence of valvular vegetations detected by echocardiography. Complementary imaging is helpful when there is ongoing clinical suspicion for IE following initially negative echocardiography. Multislice computed tomography allows for assessment of extra-cardiac complications in TVIE, including pulmonary septic emboli. 18F-fluorodeoxyglucose positron emission tomography/computed tomography and radiolabelled white blood cell, single-photon emission computed tomography provide important clinical information concerning the presence of IE in right-sided prosthetic valves or cardiac implantable electronic devices. The aim of this review is to provide an update on TVIE, discussing the role of multimodality imaging in TVIE and the management of these patients.
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Affiliation(s)
- Agostina M Fava
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Holcman K, Rubiś P, Stępień A, Graczyk K, Podolec P, Kostkiewicz M. The Diagnostic Value of 99mTc-HMPAO-Labelled White Blood Cell Scintigraphy and 18F-FDG PET/CT in Cardiac Device-Related Infective Endocarditis-A Systematic Review. J Pers Med 2021; 11:jpm11101016. [PMID: 34683157 PMCID: PMC8540535 DOI: 10.3390/jpm11101016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Treatment of cardiac arrhythmias and conduction disorders with the implantation of a cardiac implantable electronic device (CIED) may lead to complications. Cardiac device-related infective endocarditis (CDRIE) stands out as being one of the most challenging in terms of its diagnosis and management. Developing molecular imaging modalities may provide additional insights into CDRIE diagnosis. (2) Methods: We performed a systematic literature review to critically appraise the evidence for the diagnostic performance of the following hybrid techniques: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime–labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) and positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). An analysis was performed in accordance with PRISMA and GRADE criteria and included articles from PubMed, Embase and Cochrane databases. (3) Results: Initially, there were 2131 records identified which had been published between 1971–2021. Finally, 18 studies were included presenting original data on the diagnostic value of 99mTc-HMPAO-SPECT/CT or 18F-FDG PET/CT in CDRIE. Analysis showed that these molecular imaging modalities provide high diagnostic accuracy and their inclusion in diagnostic criteria improves CDRIE work-up. (4) Conclusions: 99mTc-HMPAO-SPECT/CT and 18F-FDG PET/CT provide high diagnostic value in the identification of patients at risk of CDRIE and should be considered for inclusion in the CDRIE diagnostic process.
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Affiliation(s)
- Katarzyna Holcman
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland;
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
- Correspondence:
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Agnieszka Stępień
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Katarzyna Graczyk
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Magdalena Kostkiewicz
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland;
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
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15
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Aguilera J, Hutt E, Jaber WA. Imaging of Cardiac Device-Related Infection. Front Cardiovasc Med 2021; 8:729786. [PMID: 34504881 PMCID: PMC8421771 DOI: 10.3389/fcvm.2021.729786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiac devices are frequently used in different cardiovascular conditions for the purpose of morbidity or mortality prevention. These include cardiac implantable electronic devices (CIED) like permanent pacemakers and implantable cardiac defibrillators, ventricular assistance devices (VADs), left atrial appendage occlusion (LAAO) devices like the Watchman™, atrial and ventricular septal occluders like the Amplatzer™, among others. In the past years, there has been an increase in the development of these devices as a result of a rise in the number of indications for implantation, paired with the aging and more medically complex patient population. This has led to an increase in the incidence of cardiac device-related infections, one of the most feared and serious complications which is associated with significant morbidity, mortality and financial burden. Accurate diagnosis of cardiac device-related infections is essential given the management implications which often involve removal of the infected device, removal of other prosthetic material and long-term antimicrobial therapy. Clinical and laboratory data are useful diagnostic tools but multimodality imaging is often necessary. The recently published 2020 European Heart Rhythm Association International Consensus document, which is endorsed by many expert societies, has recommended the use of multimodality imaging for the diagnosis of CIED infections. (1) This allows better disease characterization by identifying abnormal fluid collections and guiding aspiration for both diagnostic and therapeutic purposes (i.e. soft tissue ultrasound and computed tomography), evaluation for local extent of disease (i.e. transesophageal echocardiogram to evaluate for concomitant infective endocarditis), embolic manifestation of disease (i.e. computed tomography and magnetic resonance imaging) and metabolic tissue characterization (positron emission tomography and tagged white blood cell scan). (2) In addition, computed tomography (CT) allows for pre-procedural planning which has shown to be associated with better procedural outcomes.
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Affiliation(s)
- Jose Aguilera
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Erika Hutt
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
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16
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Lakkas L, Serim BD, Fotopoulos A, Iakovou I, Doumas A, Korkmaz U, Michalis LK, Sioka C. Infection of cardiac prosthetic valves and implantable electronic devices: early diagnosis and treatment. Acta Cardiol 2021; 76:569-575. [PMID: 32406333 DOI: 10.1080/00015385.2020.1761594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There has been a recent rise in the use of implantable cardiac devices, mostly valves but also electronic ones, such as pacemakers, and implantable defibrillators. The increasing use of these devices had as a consequence the raised incidence of endocarditis, an infrequent but morbid complication of these procedures. Thus, early diagnosis of the implantable cardiac devices related infection and endocarditis became pivotal for appropriate management. For diagnostic purposes, the modified Duke criteria are widely used, which are based on clinical and imaging findings, in addition to serological analyses and blood cultures. 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently employed method in order to improve the early diagnosis of endocarditis as well as infection of the implantable device. It is likely, that combining the modified Duke criteria with the FDG PET/CT, will increase the sensitivity and specificity of diagnosis and will guide the treating physician to an early and appropriate management.
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Affiliation(s)
- Lampros Lakkas
- 2nd Department of Cardiology, Medical school, University Hospital of Ioannina, Ioannina, Greece
| | - Burcu Dirlik Serim
- Department of Nuclear Medicine, Institution of Cardiology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Andreas Fotopoulos
- Department of Nuclear Medicine, Medical school, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Iakovou
- 2nd Department of Nuclear Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Argyrios Doumas
- 2nd Department of Nuclear Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Ulku Korkmaz
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Lampros K. Michalis
- 2nd Department of Cardiology, Medical school, University Hospital of Ioannina, Ioannina, Greece
| | - Chrissa Sioka
- Department of Nuclear Medicine, Medical school, University Hospital of Ioannina, Ioannina, Greece
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17
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Rodríguez-Alfonso B, Mitjavila Casanovas M, Castro Urda V, Cobo Marcos M, Sánchez Romero I, Ramos-Martínez A. PET/CT with 18F-FDG in suspected intracardiac device-related infections: analysis of performance and diagnostic usefulness. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:238-246. [PMID: 32471719 DOI: 10.1016/j.rec.2020.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/24/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Cardiac device-related infections (CDRI) may be life-threatening and require early and accurate diagnosis. The aims of this study were to analyze the performance of positron emission tomography-computed tomography (PET/CT) in suspected CDRI, to assess changes to the initial diagnosis, and to identify a clinical subgroup deriving the greatest benefit from this imaging modality. METHODS Retrospective study including patients evaluated by PET/CT for suspected CDRI from 2011 to 2018. We assessed PET/CT performance and the agreement between the initial, post-PET and definitive diagnoses. We also assessed changes in the diagnosis, depending on initial clinical suspicion, to identify patients deriving the greatest benefit from PET/CT. RESULTS We included 44 patients. The prevalence of endocarditis was 57%. The sensitivity and specificity of PET/CT for the diagnosis of infective endocarditis were 0.84 and 0.95, respectively. Post-PET diagnosis improved the initial diagnosis by 45%. PET/CT correctly reclassified 57% of patients with initial suspicion of generator pocket infection by detecting lead infection. CONCLUSIONS PET/CT showed high diagnostic performance in suspected of CDRI and significantly improved the conventional diagnostic approach, especially in patients with initial suspicion of focal infection.
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Affiliation(s)
- Begoña Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | - Víctor Castro Urda
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Marta Cobo Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Isabel Sánchez Romero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Servicio de Medicina Interna (Infectología), Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Rodríguez-Alfonso B, Mitjavila Casanovas M, Castro Urda V, Cobo Marcos M, Sánchez Romero I, Ramos-Martínez A. PET/TC con 18F-FDG en la sospecha de infección asociada a dispositivos intracardiacos: rendimiento y utilidad diagnóstica. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Sarkar S, Ganesan R, Kumar B, Singh H, Basher R, Sood A. Intraoperative transesophageal echocardiography: A complement to 18F-fluorodeoxyglucose positron emission tomography-computed tomography in localizing pacemaker lead endocarditis. Ann Card Anaesth 2020; 23:524-527. [PMID: 33109819 PMCID: PMC7879899 DOI: 10.4103/aca.aca_9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lead endocarditis (LE) is a serious complication of permanent trans-venous pacing. Localizing LE may be challenging with conventional imaging modalities. 2-deoxy-2-[fluorine-18] fluoro-D-glucose positron emission tomography–computed tomography (FDG PET/CT) has recently emerged as a promising tool in the diagnosis of LE particularly in cases with normal echocardiographic imaging findings and/or negative blood culture. However, this technique is associated with some drawbacks. Knowledge of these drawbacks and correlating its limitations with other imaging modality is essential for the echocardiographer while evaluating such patient. We report a case where transesophageal echocardiography was complementary to FDG PET/CT in the diagnosis and localization of vegetation over pacemaker leads during intraoperative period.
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Affiliation(s)
- Soumya Sarkar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajarajan Ganesan
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhupesh Kumar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Cardiac Thoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Basher
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Usefulness of 18F-FDG PET/CT in Patients with Cardiac Implantable Electronic Device Suspected of Late Infection. J Clin Med 2020; 9:jcm9072246. [PMID: 32679871 PMCID: PMC7408953 DOI: 10.3390/jcm9072246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023] Open
Abstract
The presence of a cardiovascular implantable electronic device (CIED) can be burdened by complications such as late infections that are associated with significant morbidity and mortality and require immediate and effective treatment. The aim of this study was to evaluate the role of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in patients with suspected CIED infection. Fifteen patients who performed a 18F-FDG PET/CT for suspicion of CIED infection were retrospectively analyzed; 15 patients, with CIED, that underwent 18F-FDG PET/CT for oncological reasons, were also evaluated. Visual qualitative analysis and semi-quantitative analysis were performed. All patients underwent standard clinical management regardless 18F-FDG PET/CT results. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) resulted as 90.91%, 75%, 86.67%, 90.91% and 75% respectively. Maximum standardized uptake values (SUVmax) and semi-quantitative ratio (SQR) were collected and showed differences statistically significant between CIED infected patients and those who were not. Exploratory cut-off values were derived from receiver operating characteristic (ROC) curves for SUVmax (2.56) and SQR (4.15). This study suggests the clinical usefulness of 18F-FDG PET/CT in patients with CIED infection due to its high sensitivity, repeatability and non-invasiveness. It can help the clinicians in decision making, especially in patients with doubtful clinical presentation. Future large-scale and multicentric studies should be conducted to establish precise protocols about 18F-FDG PET/CT performance.
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21
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Galea N, Bandera F, Lauri C, Autore C, Laghi A, Erba PA. Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection. J Clin Med 2020; 9:jcm9072237. [PMID: 32674517 PMCID: PMC7408824 DOI: 10.3390/jcm9072237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022] Open
Abstract
Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.
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Affiliation(s)
- Nicola Galea
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-328-223-1647
| | - Francesco Bandera
- Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Piazza Malan, 1, San Donato Milanese, 20097 Milan, Italy;
- Department of Biomedical Sciences for Health, University of Milano, Via Luigi Mangiagalli, 31, 20133 Milan, Italy
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Camillo Autore
- Department of Clinical and Molecular Sciences, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Andrea Laghi
- Radiology Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Paola Anna Erba
- Department of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56126 Pisa, Italy;
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 Groningen, The Netherlands
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Mahmood M, Abu Saleh O. The Role of 18-F FDG PET/CT in Imaging of Endocarditis and Cardiac Device Infections. Semin Nucl Med 2020; 50:319-330. [DOI: 10.1053/j.semnuclmed.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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23
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Erba PA, Slart RHJA. Radiolabeled-White Blood Cell Imaging in Cardiac Device-Related Infective Endocarditis: Worth All the Effort? JACC Cardiovasc Imaging 2020; 13:1752-1754. [PMID: 32563659 DOI: 10.1016/j.jcmg.2020.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Paola A Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy; Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
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24
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Castillo Almeida NE, Gurram P, Esquer Garrigos Z, Mahmood M, Baddour LM, Sohail MR. Diagnostic imaging in infective endocarditis: a contemporary perspective. Expert Rev Anti Infect Ther 2020; 18:911-925. [PMID: 32442039 DOI: 10.1080/14787210.2020.1773260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Infective endocarditis (IE) remains a diagnostic challenge. Prompt diagnosis is essential for accurate risk stratification and appropriate therapeutic decisions and surgical management. In recent years, the use of multimodal imaging has had a transformative effect on the diagnostic approach of IE in selected patients. AREAS COVERED This review assesses published literature on different imaging modalities for the diagnosis of IE published between 1 January 2009 and 1 February 2020. We illustrate the diagnostic approach to IE with three clinical cases. EXPERT OPINION Novel approaches to imaging for cardiac and extracardiac complications improve and individualize diagnosis, management, and prognosis in patients with suspected IE. The use of multimodal imaging should be guided by a multidisciplinary group of medical providers that includes infectious disease specialists, radiologists, cardiologists, and cardiothoracic surgeons.
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Affiliation(s)
- Natalia E Castillo Almeida
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Pooja Gurram
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Maryam Mahmood
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science , Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science , Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
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25
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Wang TKM, Sánchez-Nadales A, Igbinomwanhia E, Cremer P, Griffin B, Xu B. Diagnosis of Infective Endocarditis by Subtype Using 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Contemporary Meta-Analysis. Circ Cardiovasc Imaging 2020; 13:e010600. [PMID: 32507019 DOI: 10.1161/circimaging.120.010600] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Infective endocarditis (IE) remains a difficult to diagnose condition associated with high mortality. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently emerged as another IE imaging modality, although diagnostic accuracy varies across observational studies and types of IE. This meta-analysis assessed the diagnostic performance of 18F-FDG PET/CT for IE and its subtypes. Methods We searched Pubmed, Cochrane, and Embase from January 1980 to September 2019 for studies reporting both sensitivity and specificity of 18F-FDG PET/CT for IE. Meta-Disc 1.4 was used to pool data for all cases of IE and its subgroups of native valve IE, prosthetic valve IE, and cardiac implantable electronic devices IE. Results We screened 2566 records from the search, assessed 52 full-text articles, and included 26 studies totaling 1358 patients (509 IE cases). Pooled sensitivity and specificity (95% CI, inconsistency I-square statistic) were 0.74 (0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%) for all cases of endocarditis. Corresponding parameters for native valve IE were sensitivity 0.31 (0.21-0.41, 29.4%) and specificity 0.98 (0.95-0.99, 34.4%); for prosthetic valve IE: sensitivity 0.86 (0.81-0.89, 60.0%) and specificity 0.84 (0.79-0.88, 75.2%); and for cardiac implantable electronic devices IE: sensitivity 0.72 (0.61-0.81, 76.2%) and specificity 0.83 (0.75-0.89, 83.6%). Pooled sensitivities and specificities were higher for the 17 studies since 2015 than the 9 studies published before 2015. Conclusions 18F-FDG PET/CT had high specificity for all IE subtypes; however, sensitivity was markedly lower for native valve IE than prosthetic valve IE and cardiac implantable electronic devices IE. It is, therefore, a useful adjunct modality for assessing endocarditis, especially in the challenging scenarios of prosthetic valve IE and cardiac implantable electronic devices IE, with improving performance over time, related to advances in 18F-FDG PET/CT techniques.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (T.K.M.W., P.C., B.G., B.X.)
| | | | - Efehi Igbinomwanhia
- Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago (A.S.N., E.I.)
| | - Paul Cremer
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (T.K.M.W., P.C., B.G., B.X.)
| | - Brian Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (T.K.M.W., P.C., B.G., B.X.)
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (T.K.M.W., P.C., B.G., B.X.)
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26
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Erba PA, Pizzi MN, Roque A, Salaun E, Lancellotti P, Tornos P, Habib G. Multimodality Imaging in Infective Endocarditis: An Imaging Team Within the Endocarditis Team. Circulation 2019; 140:1753-1765. [PMID: 31738598 DOI: 10.1161/circulationaha.119.040228] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Infective endocarditis (IE) is a complex disease with cardiac involvement and multiorgan complications. Its prognosis depends on prompt diagnosis that leads to an aggressive therapeutic management combining antibiotic therapy and early cardiac surgery when indicated. However, IE diagnosis always poses a challenge, and echocardiography remains diagnostically imperfect in cases of prosthetic valve IE or cardiac implantable electronic device infection. In recent years, other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) have experienced significant technical improvements, and their application to the detection of cardiac and extracardiac IE-related lesions seems to be a strategic way forward in the management of patients with suspected IE. However, the scientific evidence in the literature remains limited; current guidelines address the use of the multimodality imaging in the field of IE with caution; the incremental value of each technique and their combinations is debated; and their use varies across countries. Despite these limitations, healthcare providers and surgeons should be aware of the possibilities offered by the multimodal imaging approach when appropriate. Here, we emphasize the value of a multidisciplinary heart valve team, the endocarditis team, underlining the importance of cardiac and extracardiac imaging experts in playing a key role in informing the diagnosis and management of patients with IE. Illustrative cases, critical appraisal of contemporary data, and conceptual and practical suggestions for clinicians that may help to improve the prognosis of patients with IE are provided in this review article.
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Affiliation(s)
- Paola A Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Italy (P.A.E.).,University of Groningen, University Medical Center Groningen, Medical Imaging Center, The Netherlands (P.A.E.)
| | - Maria N Pizzi
- Departments of Cardiology (M.N.P.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain (M.N.P., A.R., P.T.)
| | - Albert Roque
- Radiology (A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain (M.N.P., A.R., P.T.)
| | - Erwan Salaun
- APHM, La Timone Hospital, Cardiology Department, Marseille, France (E.S., G.H.)
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Belgium (P.L.).,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy (P.L.)
| | - Pilar Tornos
- Department of Cardiology, Hospital Quirónsalud, Barcelona, Spain (P.T.)
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Marseille, France (E.S., G.H.).,Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, France (G.H.)
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27
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Calais J, Touati A, Grall N, Laouénan C, Benali K, Mahida B, Vigne J, Hyafil F, Iung B, Duval X, Lepage L, Le Guludec D, Rouzet F. Diagnostic Impact of
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F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and White Blood Cell SPECT/Computed Tomography in Patients With Suspected Cardiac Implantable Electronic Device Chronic Infection. Circ Cardiovasc Imaging 2019; 12:e007188. [DOI: 10.1161/circimaging.117.007188] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background:
Cardiac implantable electronic devices (CIEDs) chronic infection diagnosis is challenging because the clinical presentation is frequently misleading and echocardiography may be inconclusive. The aim of this study was to evaluate the diagnostic value of
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F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and radiolabeled white blood cells single photon emission CT/CT in a cohort of patients who underwent both scans for suspicion of CIED infection and inconclusive routine investigations.
Methods:
Forty-eight consecutive patients with suspicion of CIED infection who underwent both
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F-fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT in a time span ≤30 days were retrospectively included. The final diagnosis of CIED infection by the endocarditis expert team was based on the modified Duke-Li classification at the end of follow-up.
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F-Fluorodeoxyglucose positron emission tomography/CT and white blood cell single photon emission CT/CT scans were independently analyzed blinded to the patients’ medical record.
Results:
In the overall study population, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were respectively 80%, 91%, 80%, and 91% for
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F-fluorodeoxyglucose positron emission tomography/CT and 60%, 100%, 100%, and 85% for white blood cell single photon emission CT/CT. Addition of a positive nuclear imaging scan as a major criterion markedly improved the Duke-Li classification at admission. Semiquantitative parameters did not allow to discriminate between definite and rejected CIED infection. Prolonged antibiotic therapy before imaging tended to decrease the sensitivity for both techniques.
Conclusions:
Nuclear imaging can improve the diagnostic performances of the Duke-Li score at admission in a selected population of patients with suspected CIED infection, particularly when the infection was initially graded as possible. Whenever possible, imaging should be performed before or early after antibiotic initiation.
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Affiliation(s)
- Jérémie Calais
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
| | - Aziza Touati
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
| | - Nathalie Grall
- INSERM, UMR 1137 (IAME), Paris, France (N.G., C.L., X.D.)
- Microbiology Laboratory (N.G.), AP-HP, Bichat Hospital, Paris, France
| | - Cédric Laouénan
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM, UMR 1137 (IAME), Paris, France (N.G., C.L., X.D.)
- Department of Biostatistics (C.L.), AP-HP, Bichat Hospital, Paris, France
| | - Khadija Benali
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Besma Mahida
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Jonathan Vigne
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Fabien Hyafil
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - Bernard Iung
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- Department of Cardiology (B.I.), AP-HP, Bichat Hospital, DHU FIRE, Paris, France
| | - Xavier Duval
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM, UMR 1137 (IAME), Paris, France (N.G., C.L., X.D.)
- INSERM, Clinical Investigation Centre, Bichat (X.D.)
| | - Laurent Lepage
- Department of Cardiac surgery (L.L.), AP-HP, Bichat Hospital, DHU FIRE, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
| | - François Rouzet
- Department of Nuclear Medicine, AP-HP, Bichat Hospital and DHU FIRE, Paris, France (J.C., A.T., K.B., B.M., J.V., F.H., D.L.G., F.R.)
- Université de Paris, F-75018, France (J.C., A.T., C.L., K.B., B.M., J.V., F.H., B.I., X.D., D.L.G., F.R.)
- INSERM UMR 1148 (LVTS), Paris, France (K.B., B.M., J.V., F.H., D.L.G., F.R.)
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Mahmood M, Kendi AT, Farid S, Ajmal S, Johnson GB, Baddour LM, Chareonthaitawee P, Friedman PA, Sohail MR. Role of 18F-FDG PET/CT in the diagnosis of cardiovascular implantable electronic device infections: A meta-analysis. J Nucl Cardiol 2019; 26:958-970. [PMID: 28913626 DOI: 10.1007/s12350-017-1063-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We performed a meta-analysis evaluating the use of fluorine-18-fluorodeoxyglucose (18F-FDG) positron-emission tomography (PET)/computed tomography (CT) in the diagnosis of cardiovascular implantable electronic device (CIED) infections. BACKGROUND PET/CT may be helpful in the diagnosis of CIED infection, particularly in patients with the absence of localizing signs or definitive echocardiographic findings. METHODS PubMed, Embase, Cochrane library, CINAHL, Web of Knowledge, and www.clinicaltrials.gov from January 1990 to April 2017 were searched for studies evaluating the accuracy of PET/CT in the diagnosis of CIED infections. RESULTS Overall, 14 studies involving 492 patients were included in the meta-analysis. The pooled sensitivity of PET/CT for diagnosis of CIED infection was 83% (95% CI 78%-86%) and the pooled specificity was 89% (95% CI 84%-94%). PET/CT demonstrated a higher sensitivity of 96% (95% CI 86%-99%) and specificity of 97% (95% CI 86%-99%) for diagnosis of pocket infections. Diagnostic accuracy for lead infections or CIED-IE was lower with pooled sensitivity of 76% (95% CI 65%-85%) and specificity of 83% (95% CI 72%-90%). CONCLUSION Use of PET/CT in the evaluation of CIED infection has both a high sensitivity (83%) and specificity (89%) and deserves consideration in the management of selected patients with suspected CIED infections.
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Affiliation(s)
- Maryam Mahmood
- Division of Infectious Disease, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Ayse Tuba Kendi
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Saira Farid
- Division of Infectious Disease, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Saira Ajmal
- Division of Infectious Disease, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Larry M Baddour
- Division of Infectious Disease, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - M Rizwan Sohail
- Division of Infectious Disease, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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29
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Ahmed FZ, Arumugam P. 18F-FDG PET/CT now endorsed by guidelines across all types of CIED infection: Evidence limited but growing. J Nucl Cardiol 2019; 26:971-974. [PMID: 29188432 DOI: 10.1007/s12350-017-1119-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Fozia Zahir Ahmed
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Parthiban Arumugam
- Nuclear Medicine Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
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30
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Abstract
Infective endocarditis (IE) is an uncommon, life-threatening systemic disorder with significant morbidity and persistently high mortality. The age of the peak incidence of IE has shifted from 45 years in the 1950s to 70 years at the present time, and elderly people have a five-fold higher risk of IE than the general adult population. Elderly IE patients demonstrate a higher prevalence of coagulase-negative staphylococci, enterococci and Streptococcus bovis, and lower rates of infection by viridans group streptococci. Methicillin resistance is more prevalent in elderly patients as a consequence of increased nosocomial acquisition. The elderly are a vulnerable group in whom diagnosis is often difficult on account of non-specific presenting features and where higher prevalence of comorbidities contributes to adverse outcomes. Treatment of older patients with IE presents specific challenges associated with prolonged antibiotic therapy, and access to surgery may be denied on account of advanced age and attendant comorbidities. This practical review covers all aspects of elderly IE, including clinical and microbiological diagnosis and appropriate diagnostic procedures, initial antibiotic selection, antibiotic prophylaxis, considerations about antibiotic therapy and surgery.
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31
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Robinson AA, Bourque JM. Emerging Techniques for Cardiovascular PET. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019; 4:13-24. [PMID: 34552704 PMCID: PMC8455121 DOI: 10.15212/cvia.2019.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The application of positron emission tomography (PET) to cardiac disease has yielded tremendous developments in the evaluation of coronary artery, myocardial, and valvular heart disease over the past several decades. These advances have included development of new radiotracers, incremental technological improvements, and coupling of PET with other non-invasive cardiac imaging modalities. The current era has seen rapid, successive and wide-ranging advances in PET myocardial perfusion and metabolic imaging. This review will address emerging techniques in cardiovascular PET imaging, including the measurement of absolute myocardial blood flow (MBF), use of novel tracers, and other advances in heart failure, infection imaging, and valvular disease.
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Affiliation(s)
- Austin A. Robinson
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Jamieson M. Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
- Department of Radiology, University of Virginia Health System, Charlottesville, VA
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Sordelli C, Fele N, Mocerino R, Weisz SH, Ascione L, Caso P, Carrozza A, Tascini C, De Vivo S, Severino S. Infective Endocarditis: Echocardiographic Imaging and New Imaging Modalities. J Cardiovasc Echogr 2019; 29:149-155. [PMID: 32089994 PMCID: PMC7011492 DOI: 10.4103/jcecho.jcecho_53_19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infective endocarditis (IE) is a rare disease with a significant impact and an increasing mortality despite earlier diagnosis and surgical intervention. It is related to several and the main etiological agents are the Gram-positive cocci. The new guidelines propose new diagnostic criteria that consider the potentiality on integrated multimodality imaging. Echocardiography (TTE) plays a key role for the diagnosis of IE and must be performed as soon as IE is suspected. It allows to identify vegetation, abscess, new dehiscence of prosthetic valve and assesses the number, size, shape, location, echogenicity and mobility of vegetations so it also useful for prediction embolic risk. Transesophageal echocardiography (TEE) is indicated when TTE is positive or non diagnostic, in case of suspected complications and when intracardiac device leads are present. We underline the increasing role of three-dimensional (3D) echocardiography in overcoming the limit of 2DTEE in selecting the maximum true diameter of irregular masses (ie, vegetation). We also underline the diagnostic value of multislice computed tomograpfy (MSCT), cerebral magnetic resonance (RMI) and nuclear imaging and also emphasize the emerging role of particular types of endocarditis specially Lead Endocarditis. The aim of this review is to provide an overview of the imaging techniques useful for the diagnosis and identification of any complications. In our opinion, the management of IE is complex, based on an “Endocarditis team “ composed by several specialist and an integrated multimodality imaging is essential for the diagnostic approach.
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Affiliation(s)
- Chiara Sordelli
- Department of Cardiology, AORN Ospedali dei Colli-Cotugno, Naples, Italy
| | - Nunzia Fele
- Department of Cardiology, AORN Ospedali dei Colli-Cotugno, Naples, Italy
| | - Rosa Mocerino
- Department of Cardiology, AORN Ospedali dei Colli-Cotugno, Naples, Italy
| | - Sara Hana Weisz
- Department of Cardiology, AORN Ospedali dei Colli-Cotugno, Naples, Italy
| | - Luigi Ascione
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Pio Caso
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Antonio Carrozza
- Department of Cardiothoracic Surgery, Second University of Naples, Naples, Italy
| | - Carlo Tascini
- Department of Infectious Disease, AORN Ospedali dei Colli-Cotugno, Naples, Italy
| | - Stefano De Vivo
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Sergio Severino
- Department of Cardiology, AORN Ospedali dei Colli-Cotugno, Naples, Italy
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Sambuceti G, Morbelli S, Orengo AM, Bauckneht M, Marini C. 18F-Fluorodeoxyglucose Imaging of Inflammation: Ready to Represent a Standard in Diagnosing Endocarditis? Circ Cardiovasc Imaging 2018; 10:e006185. [PMID: 28298288 DOI: 10.1161/circimaging.117.006185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Gianmario Sambuceti
- From the Department of Health Sciences, University of Genoa, Italy (G.S., M.B.); Nuclear Medicine Unit, IRCCS San Martino-IST, Genoa, Italy (G.S., S.M., A.M.O., C.M.); and CNR Institute of Bioimages and Molecular Physiology, Milan, Italy (C.M.).
| | - Silvia Morbelli
- From the Department of Health Sciences, University of Genoa, Italy (G.S., M.B.); Nuclear Medicine Unit, IRCCS San Martino-IST, Genoa, Italy (G.S., S.M., A.M.O., C.M.); and CNR Institute of Bioimages and Molecular Physiology, Milan, Italy (C.M.)
| | - Anna Maria Orengo
- From the Department of Health Sciences, University of Genoa, Italy (G.S., M.B.); Nuclear Medicine Unit, IRCCS San Martino-IST, Genoa, Italy (G.S., S.M., A.M.O., C.M.); and CNR Institute of Bioimages and Molecular Physiology, Milan, Italy (C.M.)
| | - Matteo Bauckneht
- From the Department of Health Sciences, University of Genoa, Italy (G.S., M.B.); Nuclear Medicine Unit, IRCCS San Martino-IST, Genoa, Italy (G.S., S.M., A.M.O., C.M.); and CNR Institute of Bioimages and Molecular Physiology, Milan, Italy (C.M.)
| | - Cecilia Marini
- From the Department of Health Sciences, University of Genoa, Italy (G.S., M.B.); Nuclear Medicine Unit, IRCCS San Martino-IST, Genoa, Italy (G.S., S.M., A.M.O., C.M.); and CNR Institute of Bioimages and Molecular Physiology, Milan, Italy (C.M.)
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García-Arribas D, Vilacosta I, Ortega Candil A, Rodríguez Rey C, Olmos C, Pérez Castejón MJ, Vivas D, Pérez-García CN, Carnero-Alcázar M, Fernández-Pérez C, Maroto L, Carreras JL. Usefulness of positron emission tomography/computed tomography in patients with valve-tube graft infection. Heart 2018; 104:1447-1454. [DOI: 10.1136/heartjnl-2017-312918] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023] Open
Abstract
ObjectiveInfection of valved aortic grafts is a rare entity whose diagnosis remains challenging. Positron emission tomography (PET)/CT has become a criterion for the diagnosis of infective endocarditis (IE) in prosthetic valves, but its role on ascending aortic graft infections remains unclear. This study aims to assess the diagnostic value of PET/CT in patients with valved aortic graft infection.Methods12 episodes with a valved aortic graft who had undergone a PET/CT due to suspicion of IE were prospectively included (group I) and compared with five controls free of infection who underwent PET/CT for other reasons (group II). Pathological uptake of 18F-fluorodeoxyglucose (FDG) and its pattern at the prosthetic valve and aortic graft were studied.ResultsDiagnosis of IE was confirmed in 9 out of 12 episodes of group I. 18F-FDG uptake was detectable in eight out of nine cases with a final diagnosis of IE. The most repeated pattern of uptake was homogeneous around the valve and heterogeneous around the tube. There was one false-negative study. Of the three patients in which IE was ruled out, there were two false positives and one true negative. In group II, there were three patients with a positive PET/CT study, two of them had active aortitis and the third was considered false positive.Conclusions18F-FDG PET/CT shows high sensitivity in the detection of infected aortic grafts. Thus, this technique should be considered in the diagnostic work-up of patients with suspicion of aortic graft infection. However, further validation of this approach is needed.
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Cantoni V, Sollini M, Green R, Berchiolli R, Lazzeri E, Mannarino T, Acampa W, Erba PA. Comprehensive meta-analysis on [18F] FDG PET/CT and radiolabelled leukocyte SPECT–SPECT/CT imaging in infectious endocarditis and cardiovascular implantable electronic device infections. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0265-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Juneau D, Golfam M, Hazra S, Erthal F, Zuckier LS, Bernick J, Wells GA, Beanlands RSB, Chow BJW. Molecular Imaging for the diagnosis of infective endocarditis: A systematic literature review and meta-analysis. Int J Cardiol 2017; 253:183-188. [PMID: 29137818 DOI: 10.1016/j.ijcard.2017.10.116] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/12/2017] [Accepted: 10/31/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is a serious, potentially life-threatening condition. Currently, the modified Duke criteria is used to assist with the diagnosis of IE, but it can still remain difficult. Growing data supports the potential use of molecular imaging to assist in the diagnosis of IE. Our objective was to understand the potential utility of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT), 67Ga citrate and radiolabeled white blood cell (WBC) scintigraphy in the diagnosis of IE. METHODS AND RESULTS A systematic review of the literature and meta-analysis on the use of all 3 modalities in IE was conducted. The literature search identified 2753 articles. A total of 14 studies met the inclusion criteria (10 for 18F-FDG, 3 for WBC and 1 for both modalities). No 67Ga citrate study met the inclusion criteria. Pooled sensitivity of 18F-FDG studies with adequate cardiac preparation for the diagnosis of IE was 81% (95% CI, 73%-86%) and pooled specificity was 85% (95% CI, 78%-91%). There was good overall accuracy with an area under the curve (AUC) of 0.897. Pooled sensitivity of WBC for the diagnosis of IE was 86% (95% CI, 77%-92%) and pooled specificity was 97% (95% CI, 92%-99%). The overall accuracy of WBC was excellent with an AUC of 0.957. CONCLUSIONS Both 18F-FDG and WBC have good sensitivity, specificity and accuracy for the diagnosis of IE. Both modalities are useful in the investigation of IE, and should be considered in cases where the diagnosis is uncertain.
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Affiliation(s)
- Daniel Juneau
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mohammad Golfam
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Samir Hazra
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Fernanda Erthal
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lionel S Zuckier
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jordan Bernick
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
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Roque A, Pizzi MN, Cuéllar-Calàbria H, Aguadé-Bruix S. 18F-FDG-PET/CT Angiography for the Diagnosis of Infective Endocarditis. Curr Cardiol Rep 2017; 19:15. [PMID: 28185172 DOI: 10.1007/s11886-017-0824-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current imaging role of 18F-fluordeoxyglucose positron emission computed tomography (18F-FDG-PET/CT) combined with cardiac CT angiography (CTA) in infective endocarditis and discusses the strengths and limitations of this technique. RECENT FINDINGS The diagnosis of infective endocarditis affecting prosthetic valves and intracardiac devices is challenging because echocardiography and, therefore, the modified Duke criteria have well-recognized limitations in this clinical scenario. The high sensitivity of 18F-FDG-PET/CT for the detection of infection associated with the accurate definition of structural damage by gated cardiac CTA in a combined technique (PET/CTA) has provided a significant increase in diagnostic sensitivity for the detection of IE. PET/CTA has proven to be a useful diagnostic tool in patients with suspected infective endocarditis. The additional information provided by this technique improves diagnostic performance in prosthetic valve endocarditis when it is used in combination with the Duke criteria. The findings obtained in PET/CTA studies have been included as a major criterion in the recently updated diagnostic algorithm in infective endocarditis guidelines.
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Affiliation(s)
- A Roque
- Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,IDI (Institut de Diagnòstic per la Imatge), Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - M N Pizzi
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - H Cuéllar-Calàbria
- Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.,IDI (Institut de Diagnòstic per la Imatge), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - S Aguadé-Bruix
- Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 710] [Impact Index Per Article: 101.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
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Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, Schäfers HJ, Prendergast BD. Challenges in Infective Endocarditis. J Am Coll Cardiol 2017; 69:325-344. [PMID: 28104075 DOI: 10.1016/j.jacc.2016.10.066] [Citation(s) in RCA: 368] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/26/2016] [Accepted: 10/30/2016] [Indexed: 02/06/2023]
Abstract
Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It is frequently acquired in the health care setting, and more than one-half of cases now occur in patients without known heart disease. Despite optimal care, mortality approaches 30% at 1 year. The challenges posed by infective endocarditis are significant. It is heterogeneous in etiology, clinical manifestations, and course. Staphylococcus aureus, which has become the predominant causative organism in the developed world, leads to an aggressive form of the disease, often in vulnerable or elderly patient populations. There is a lack of research infrastructure and funding, with few randomized controlled trials to guide practice. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved. The present article reviews the challenges posed by infective endocarditis and outlines current and future strategies to limit its impact.
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Affiliation(s)
- Thomas J Cahill
- Department of Cardiology, Oxford University Hospitals, Oxford, United Kingdom
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gilbert Habib
- Aix-Marseille Universite, URMITE, Marseille, France; APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Bruno Hoen
- Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Inserm, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Centre Hospitalier Universitaire de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, France
| | - Erwan Salaun
- APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Hans Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Pozo E, Olmos C, de Agustín JA, Jiménez-Ballvé A, Pérez de Isla L, Macaya C. Avances en el diagnóstico por imagen de la endocarditis infecciosa izquierda. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Juneau D, Golfam M, Hazra S, Zuckier LS, Garas S, Redpath C, Bernick J, Leung E, Chih S, Wells G, Beanlands RSB, Chow BJW. Positron Emission Tomography and Single-Photon Emission Computed Tomography Imaging in the Diagnosis of Cardiac Implantable Electronic Device Infection: A Systematic Review and Meta-Analysis. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005772. [PMID: 28377468 DOI: 10.1161/circimaging.116.005772] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of cardiac implantable electronic devices (CIED) is increasing, and their associated infections result in significant morbidity and mortality. The introduction of better cardiac imaging techniques could be useful for diagnosing this condition and guiding therapy. Our objective was to systematically assess the diagnostic accuracy of Fluor-18-fluorodeoxyglucose positron emission tomography and computed tomography, labeled leukocyte scintigraphy (LS), and Gallium-67 citrate scintigraphy for the diagnosis of CIED infection. METHODS AND RESULTS A systematic review of the literature and meta-analysis on the use of all 3 modalities in CIED infection were conducted. Pooled sensitivity, specificity, and summary receiver operating characteristic curves of each imaging modalities were determined. The literature search identified 2493 articles. A total of 13 articles (11 studies for 18F-FDG PET-CT and 2 for LS), met the inclusion criteria. No studies for 67Ga citrate scintigraphy met the inclusion criteria. The pooled sensitivity of 18F-FDG PET-CT for the diagnosis of CIED infection was 87% (95% CI, 82%-91%) and pooled specificity was 94% (95% CI, 88%-98%). The summary receiver operating characteristic curve analysis demonstrated good overall accuracy, with an area under the curve of 0.935. There were insufficient data to do a meta-analysis for LS, but both studies reported sensitivity above 90% and specificity of 100%. CONCLUSIONS Both 18F-FDG PET-CT and LS yield high sensitivity, specificity, and accuracy, and thus seem to be useful for the diagnosis of CIED infection, based on robust data for 18F-FDG PET-CT but limited data for LS. When available,18F-FDG PET-CT may be preferred.
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Affiliation(s)
- Daniel Juneau
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Mohammad Golfam
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Samir Hazra
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Lionel S Zuckier
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Shady Garas
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Calum Redpath
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Jordan Bernick
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Eugene Leung
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Sharon Chih
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - George Wells
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Rob S B Beanlands
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.)
| | - Benjamin J W Chow
- From the Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada (D.J., S.H., C.R., J.B., S.C., G.W., R.S.B.B., B.J.W.C.); Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ontario, Canada (M.G., L.S.Z., S.G., E.L.); and Division of Nuclear Medicine, Medical Imaging Department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada (D.J.).
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Tawakol A, Osborne MT, Fayad ZA. Molecular Imaging of Atheroma: Deciphering How and When to Use 18F-Sodium Fluoride and 18F-Fluorodeoxyglucose. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006183. [PMID: 28292862 DOI: 10.1161/circimaging.117.006183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ahmed Tawakol
- From the Cardiology Division Department of Medicine, and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (A.T., M.T.O); and Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.).
| | - Michael T Osborne
- From the Cardiology Division Department of Medicine, and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (A.T., M.T.O); and Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Zahi A Fayad
- From the Cardiology Division Department of Medicine, and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (A.T., M.T.O); and Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
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Kircher M, Lapa C. Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017; 10:6. [PMID: 28357026 PMCID: PMC5352761 DOI: 10.1007/s12410-017-9400-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Inflammation is a key player in a wide range of cardiovascular and myocardial diseases. Given the numerous implications of inflammatory processes in disease initiation and progression, functional imaging modalities including positron emission tomography (PET) represent valuable diagnostic, prognostic, and monitoring tools in patient management. Since increased glucose metabolism is a hallmark of inflammation, PET using the radiolabeled glucose analog [18F]-2-deoxy-2-fluoro-d-glucose (FDG) is the mainstay diagnostic test for nuclear imaging of (cardiac) inflammation. Recently, new approaches using more specific tracers to overcome the limited specificity of FDG have emerged. RECENT FINDINGS PET imaging has proven its value in a number of inflammatory conditions of the heart including myocarditis, endocarditis, sarcoidosis, or reactive changes after myocardial infarction. In infection-related endocarditis, FDG-PET and white blood cell scintigraphy have been implemented in current guidelines. FDG-PET is considered as nuclear medical gold standard in myocarditis, pericarditis, or sarcoidosis. Novel strategies, including targeting of somatostatin receptors or C-X-C motif chemokine receptor CXCR4, have shown promising results in first studies. SUMMARY Nuclear medicine techniques offer valuable information in the assessment of myocardial inflammation. Given the possibility to directly visualize inflammatory activity, they represent useful tools for diagnosis, risk stratification, and therapy monitoring.
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Affiliation(s)
- Malte Kircher
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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Osborne MT, Hulten EA, Murthy VL, Skali H, Taqueti VR, Dorbala S, DiCarli MF, Blankstein R. Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation. J Nucl Cardiol 2017; 24:86-99. [PMID: 27277502 PMCID: PMC5841447 DOI: 10.1007/s12350-016-0502-7] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/20/2016] [Indexed: 12/20/2022]
Abstract
Although the number of clinical applications for fluorine-18 fluorodeoxyglucose (18F-FDG) cardiac positron emission tomography (PET) has continued to grow, there remains a lack of consensus regarding the ideal method of suppressing normal myocardial glucose utilization for image optimization. This review describes various patient preparation protocols that have been used as well as the success rates achieved in different studies. Collectively, the available literature supports using a high-fat, no-carbohydrate diet for at least two meals with a fast of 4-12 hours prior to 18F-FDG PET imaging and suggests that isolated fasting for less than 12 hours and supplementation with food or drink just prior to imaging should be avoided. Each institution should adopt a protocol and continuously monitor its effectiveness with a goal to achieve adequate myocardial suppression in greater than 80% of patients.
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Affiliation(s)
- Michael T Osborne
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | - Edward A Hulten
- Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hicham Skali
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Viviany R Taqueti
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Sharmila Dorbala
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Marcelo F DiCarli
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Ron Blankstein
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
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Thuny F, Habib G, Raoult D, Fournier PE. Endocarditis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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47
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Infection des dispositifs cardiaques implantables. Presse Med 2017; 46:120-121. [DOI: 10.1016/j.lpm.2016.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 07/10/2016] [Accepted: 09/05/2016] [Indexed: 11/19/2022] Open
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Memmott MJ, James J, Armstrong IS, Tout D, Ahmed F. The performance of quantitation methods in the evaluation of cardiac implantable electronic device (CIED) infection: A technical review. J Nucl Cardiol 2016; 23:1457-1466. [PMID: 26403147 DOI: 10.1007/s12350-015-0106-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Quantitative assessment of [18F]-FDG PET/CT images has been shown to be useful in the diagnosis of cardiac implantable electronic device (CIED) infection. This study aimed to compare the accuracy of various quantitative methods, using the same patient cohort and to assess the utility of dual time point imaging. METHODS The study comprised a retrospective review of 80 [18F]-FDG PET/CT studies. Of these, 41 were oncological patients with an asymptomatic CIED in situ (Group 1), and 39 were studies performed in patients with symptomatic devices. Of these, 14 were subsequently deemed on follow-up to be non-infected (Group 2), and 25 confirmed as infected post-device extraction (Group 3). Ratios of maximal uptake around the CIED in both the attenuation corrected and non-attenuation corrected images were calculated to regions of normal physiological uptake, along with the maximal standardized uptake value (SUVmax) alone. Receiver operating characteristic analysis was performed for all methods at both time points. Measurement reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS Using Group 1 as a reference, all methods gave an area under the curve (AUC) greater than 0.93. Using Group 2 as reference, the accuracy varied greatly, with AUC values ranging from 0.71 to 0.97. The hepatic blood pool (HBP) ratio gave the highest AUC values. The calculated ICC values for each method showed the SUVmax and HBP measurement to have the greatest reliability, with values of 1.0 and 0.97, respectively. CONCLUSIONS Quantitation of [18F] FDG uptake was found to have a high degree of accuracy in confirming the diagnosis of CIED infection. Normalization to HBP uptake was found to give the greatest AUC and demonstrated excellent reliability. Inconsistencies from published data indicate that individual imaging centers should only use published data for guidance.
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Affiliation(s)
- Matthew J Memmott
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom.
| | - Jacqueline James
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - Ian S Armstrong
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - Deborah Tout
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - Fozia Ahmed
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Alternative Cardiac Imaging Modalities to Echocardiography for the Diagnosis of Infective Endocarditis. Am J Cardiol 2016; 118:1410-1418. [PMID: 27600463 DOI: 10.1016/j.amjcard.2016.07.053] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/26/2022]
Abstract
Infective endocarditis (IE) is a life-threatening disease. Considered the gold standard for the diagnosis of IE, the modified Duke criteria rely on echocardiographic findings to satisfy its major criterion. Echocardiography is an invaluable tool in the evaluation of patients with suspected IE but suffers from certain limitations. For example, it cannot differentiate vegetation from clot, or between infected and noninfected vegetation, and may miss vegetation and periannular extensions in the presence of prosthetic material. Therefore, alternative cardiac imaging modalities are needed. Nuclear imaging, particularly 18F-fluorodesoxyglucose positron emission tomography-computed tomography (CT), is becoming increasingly popular in the evaluation of patients for IE and has shown promise in diagnosing valvular and device-related IE when echocardiography results were inconclusive. Other techniques such as radiolabeled leukocyte scintigraphy and single-photon emission computed tomography with or without CT are less well studied, however. Cardiac CT angiography is also evolving as a powerful supplementary tool to echocardiography for the detection of perivalvular complications of IE and for preoperative evaluation of coronary anatomy. The combination of cardiac CT angiography and echocardiography is superior to either test alone in the diagnosis of IE and its complications. Although brain magnetic resonance imaging may impact prognosis and clinical management by identifying cerebral emboli in patients with IE, the role of cardiac and abdominal magnetic resonance imaging is less clear. In conclusion, with these additional diagnostic tools at our disposal, the diagnosis of IE may be achieved in a more timely and accurate manner to secure better clinical outcomes.
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Gomes A, Glaudemans AWJM, Touw DJ, van Melle JP, Willems TP, Maass AH, Natour E, Prakken NHJ, Borra RJH, van Geel PP, Slart RHJA, van Assen S, Sinha B. Diagnostic value of imaging in infective endocarditis: a systematic review. THE LANCET. INFECTIOUS DISEASES 2016; 17:e1-e14. [PMID: 27746163 DOI: 10.1016/s1473-3099(16)30141-4] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 05/05/2016] [Accepted: 05/25/2016] [Indexed: 12/19/2022]
Abstract
Sensitivity and specificity of the modified Duke criteria for native valve endocarditis are both suboptimal, at approximately 80%. Diagnostic accuracy for intracardiac prosthetic material-related infection is even lower. Non-invasive imaging modalities could potentially improve diagnosis of infective endocarditis; however, their diagnostic value is unclear. We did a systematic literature review to critically appraise the evidence for the diagnostic performance of these imaging modalities, according to PRISMA and GRADE criteria. We searched PubMed, Embase, and Cochrane databases. 31 studies were included that presented original data on the performance of electrocardiogram (ECG)-gated multidetector CT angiography (MDCTA), ECG-gated MRI, 18F-fluorodeoxyglucose (18F-FDG) PET/CT, and leucocyte scintigraphy in diagnosis of native valve endocarditis, intracardiac prosthetic material-related infection, and extracardiac foci in adults. We consistently found positive albeit weak evidence for the diagnostic benefit of 18F-FDG PET/CT and MDCTA. We conclude that additional imaging techniques should be considered if infective endocarditis is suspected. We propose an evidence-based diagnostic work-up for infective endocarditis including these non-invasive techniques.
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Affiliation(s)
- Anna Gomes
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joost P van Melle
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tineke P Willems
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ehsan Natour
- Department of Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Niek H J Prakken
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ronald J H Borra
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Peter Paul van Geel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Biomedical Photonic Imaging, University of Twente, Enschede, Netherlands
| | - Sander van Assen
- Department of Internal Medicine, Division of Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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