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Utilization of 18-FDG-PET/CT in the diagnosis of prosthetic valve endocarditis
Session:
Comunicações Orais - Sessão 22 - Ressonância Magnética e Cardiologia Nuclear
Speaker:
Gonçalo Ferraz Costa
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gonçalo Ferraz Costa; Gonçalo Terleira Batista; Diogo Fernandes; Eric Monteiro; Joana Guimarães; Ana Luísa Silva; Mariana Simões; Tatiana Santos; Ana Vera Marinho; Gracinda Costa; Rodolfo Silva; Lino Gonçalves; Maria João Ferreira
Abstract
<p><strong>Background</strong>: The diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic valve infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT</p> <p><br /> <strong>Purpose</strong>: We aim to understand the diagnostic value of 18F-FDG PET/CT in suspected PVE.</p> <p><strong>Methods</strong>: A retrospective study was performed at a tertiary center with 18F-FDG PET/CT and included all referred patients for this exam for suspected IE between May 2016 and January 2022. The choice to perform 18F-FDG PET/CT and the IE suspicion were based on the attending endocarditis team and did not follow a standardized protocol. Baseline demographic characteristics of patients, including all relevant clinical data, were collected from hospital records at hospital admission. The<br /> final diagnosis of IE (gold standard) was established by consulting the final diagnosis attributed to the patient by the Endocarditis team at the time of hospital discharge or death, after possession of clinical, microbiological, and imaging information as well as clinical response. Sensitivity, specificity, and positive and negative predictive values of 18F-FDG PET/CT in the evaluation of PVE were estimated.</p> <p><br /> <strong>Results</strong>: In total, 87 patients were included (mean age of 62 +/- 19 years, 62% of the male gender), of which 38 had at least one prosthetic valve. In the latter group, approximately 71% were male, with a median age of 63 (IQR 59-77) years. 26% were diabetic, 66% had dyslipidaemia and 74% were hypertensive. Regarding the prothesis characteristics, 71% had an aortic position, 18% mitral position and the rest had multiple valve prothesis. 58% had biological valves, 5% of the patients had both<br /> mechanical and biological and one patient (3%) had a Mitraclip. Additionally, one single patient had prosthetic material due to previous truncus arteriosus surgical correction. Fever was present in 84% of patients and 16% had signs of heart failure. Moreover, 13% had evidence of vascular phenomena. One patient, who also had an implanted cardiac device, had pocket infection signs. Laboratory results showed a mean CRP of 14.3 mg/dL and mean leucocyte count of 10.8 G/L. Only 47% had a positive<br /> blood culture. 37.5% had echocardiographic findings suggesting IE with the presence of vegetations in 77% of these. According to the Duke Criteria, 55% were classified as "possible diagnosis", 29% with "definitive diagnosis" and 13% as "rejected diagnosis". Of the suspected PVE patients, compatible findings in 18F-FDG PET/CT observed in 25 patients. Calculated sensibility was 95% and specificity was 86%.</p> <p><strong>Conclusion</strong>: Our study suggests that 18F-FDG PET/CT is a great imaging tool of for patients with PVE suspicion.</p>
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