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Funding This study was funded by INTERREG project EurHealth-1Health (Project Number 202085).
Multimodality imaging is recommended to diagnose infective endocarditis. Value of additional imaging to echocardiography in patients selected by a previously proposed flowchart has not been evaluated.
An observational single-center study was performed. Adult patients suspected of endocarditis/device infection were prospectively and consecutively enrolled from March 2016 to August 2017. Adherence to a diagnostic imaging-in-endocarditis-flowchart was evaluated in 176 patients. Imaging techniques were compared head-to-head in 46 patients receiving echocardiography (transthoracic plus transesophageal), multi-detector computed tomography angiography (MDCTA), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT).
69% of patients (121/176) adhered to the flowchart. Sensitivity of echocardiography, MDCTA, FDG-PET/CT in patients without prosthesis was 71%, 57%, 29% (86% when combined), while specificity was 100%, 75%, 100%, respectively. Sensitivity in patients with prosthesis was 75%, 75%, 83%, respectively (100% when combined), while specificity was 86% for all three modalities. Echocardiography performed best in the assessment of vegetations, morphological valve abnormalities/dehiscence, septum defects, and fistula formation. MDCTA performed best in the assessment of abscesses and ventricular assist device infection. FDG-PET/CT performed best in the assessment of cardiac device infection, extracardiac infectious foci, and alternative diagnoses.
This study demonstrates that the evaluated imaging-in-endocarditis-flowchart is applicable in daily clinical practice. Echocardiography, MDCTA, and FDG-PET/CT provide relevant complementary diagnostic information, particularly in patients with intracardiac prosthetic material.
Habets J. Computed tomography of prosthetic heart valves. PhD thesis, Utrecht University, the Netherlands 2012: Full-text available at http://dspace.library.uu.nl/handle/1874/243557.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075-128. CrossRefPubMed
Pizzi MN, Roque A, Fernandez-Hidalgo N, Cuellar-Calabria H, Ferreira-Gonzalez I, Gonzalez-Alujas MT, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-Fluordeoxyglucose Positron Emission Tomography/Computed Tomography Angiography: Initial results at an infective endocarditis referral center. Circulation 2015;132:1113-26. CrossRefPubMed
Pizzi MN, Dos-Subira L, Roque A, Fernandez-Hidalgo N, Cuellar-Calabria H, Pijuan Domenech A, et al. 18F-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material. Int J Cardiol 2017;248:396-402. CrossRefPubMed
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 2014;63(22):e57-185. CrossRefPubMed
Jimenez-Ballve A, Perez-Castejon MJ, Delgado-Bolton RC, Sanchez-Enrique C, Vilacosta I, Vivas D, et al. Assessment of the diagnostic accuracy of 18F-FDG PET/CT in prosthetic infective endocarditis and cardiac implantable electronic device infection: Comparison of different interpretation criteria. Eur J Nucl Med Mol Imaging 2016;43:2401-12. CrossRefPubMed
- Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques
MD, PhD Anna Gomes
MD, PhD Peter Paul van Geel
MD Michiel Santing
MD, PhD Niek H. J. Prakken
BSc Mathilde L. Ruis
MD, PhD Sander van Assen
MD, PhD Riemer H. J. A. Slart
MD, PhD Bhanu Sinha
MD, PhD Andor W. J. M. Glaudemans
- Springer US
- Journal of Nuclear Cardiology
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