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Diagnostic value of 18-FDG-PET/CT in the diagnosis of cardiac implantable devices
Session:
Comunicações Orais - Sessão 22 - Ressonância Magnética e Cardiologia Nuclear
Speaker:
Gonçalo Terleira Batista
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 Terleira Batista; Gonçalo Ferraz Costa; Ana Luísa Silva; Mariana Simões; Tatiana Santos; Eric Monteiro; Joana Guimarães; Diogo Fernandes; Rafaela Fernandes; Ana Vera Marinho; Gracinda Costa; Rodolfo Silva; Lino Gonçalves; M.J. 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, particularly in the presence of cardiac implantable electronic devices (CIED).</p> <p><strong>Purpose:</strong> We aim to understand the diagnostic value of 18F-FDG PET/CT in suspected CIED infection.</p> <p><strong>Methods:</strong> A retrospective analysis 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 was based on the<br /> 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 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 CIED infection were estimated.</p> <p><strong>Results:</strong> In total, 87 patients were included (mean age of 62 +/- 19 years, 62% of the male gender), of which 10 had CIED. In this subgroup, approximately 45% were male, with a median age of 75 (IQR 60-83) years. Moreover, 40% were diabetic, 65% had dyslipidemia and 75% were<br /> hypertensive. Regarding the CIED, pacemaker was the most common device found (65%), followed by cardiac resynchronization therapy defibrillator (15%), cardiac defibrillator (10%), and cardiac resynchronization therapy pacemaker (5%). Fever was present in 80% of patients and 40% had signs of heart failure. However, only one patient presented with signs of pocket infection. Laboratory results showed a mean C-reactive protein of 15.9 mg/dL and a mean leucocyte count of 10.5 G/L. Only 55% had a positive blood culture and 40% had echocardiographic findings suggesting IE with 26% presenting with moderate-severe valve regurgitation. According to the Duke Criteria, 60% were classified as "possible diagnosis", 20%<br /> with "definitive diagnosis"; and 20% as "rejected diagnosis". Of the suspected CIED infection patients, compatible findings in 18F-FDG PET/CT were observed in 7 patients. Calculated sensibility was 78% and specificity was 100%.</p> <p><strong>Conclusion:</strong> Our study suggests that 18F-FDG PET/CT is a great imaging tool for patients with CIED infection suspicion.</p>
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