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

BACKGROUND

Diagnostic and patients' management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients.

METHODS

In sum, 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients' management plan were established jointly by 2 experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients' management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established.

RESULTS

Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (P < .001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (P = .005) (net reclassification index 20% and 4.3%). Patients' managements were modified in 21.4% PV and 31.4% NV patients (P = .25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% confidence interval: 32-48), which was most likely to occur in those with a noncontributing echocardiography (P < .001) or IE classified as possible at baseline (P = .04), while there was no difference between NV and PV.

CONCLUSIONS

Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients.

CLINICAL TRIALS REGISTRATION

NCT02287792.

Author Correction: Phenological shifts alter the seasonal structure of pollinator assemblages in Europe

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Phenological shifts alter the seasonal structure of pollinator assemblages in Europe

Pollinators play an important role in terrestrial ecosystems by providing key ecosystem functions and services to wild plants and crops, respectively. The sustainable provision of such ecosystem functions and services requires diverse pollinator communities over the seasons. Despite evidence that climate warming shifts pollinator phenology, a general assessment of these shifts and their consequences on pollinator assemblages is still lacking. By analysing phenological shifts of over 2,000 species, we show that, on average, the mean flight date of European pollinators shifted to be 6 d earlier over the last 60 yr, while their flight period length decreased by 2 d. Our analysis further reveals that these shifts have probably altered the seasonal distribution of pollination function and services by decreasing the overlap among pollinators' phenologies within European assemblages, except in the most northeastern part of Europe. Such changes are expected to decrease the functional redundancy and complementarity of pollinator assemblages and, therefore, might alter the performance of pollination function and services and their robustness to ongoing pollinator extinctions.