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Moreira GS, Feijóo NDAP, Tinoco-da-Silva IB, Aguiar CM, da Conceição FO, de Castro GCM, de Carvalho MGB, de Almeida TVDPA, Garrido RQ, Lamas CDC. Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses. Trop Med Infect Dis 2024; 9:83. [PMID: 38668544 PMCID: PMC11053958 DOI: 10.3390/tropicalmed9040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8-34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.
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Affiliation(s)
- Gabriel Santiago Moreira
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
| | - Nícolas de Albuquerque Pereira Feijóo
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Isabella Braga Tinoco-da-Silva
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
| | - Cyntia Mendes Aguiar
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | | | - Gustavo Campos Monteiro de Castro
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Mariana Giorgi Barroso de Carvalho
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Thatyane Veloso de Paula Amaral de Almeida
- Department of Medicine, Universidade do Grande Rio/Afya (UNIGRANRIO/Afya), Barra da Tijuca, Rio de Janeiro 22775-003, Rio de Janeiro, Brazil; (G.S.M.); (N.d.A.P.F.)
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
| | - Rafael Quaresma Garrido
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
| | - Cristiane da Cruz Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Rio de Janeiro, Brazil; (C.M.A.); (F.O.d.C.); (R.Q.G.)
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-360, Rio de Janeiro, Brazil
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Sathyamurthy I, Elangovan I. 18F- FDG PET/CT in reclassifying the probable diagnosis of IE - A review. Indian Heart J 2024; 76:10-15. [PMID: 38185328 PMCID: PMC10943555 DOI: 10.1016/j.ihj.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024] Open
Abstract
In the diagnosis of infective endocarditis (IE), Modified Duke's criteria, coupled with clinical suspicion, serve as the guiding framework. For cases involving prosthetic valve endocarditis and infections affecting implantable devices, the use of metabolic imaging with 18 F-FDG PET/CT scans has gained prominence, as per the recommendations of the European Society of Cardiology guidelines. This imaging modality enhances sensitivity and specificity by identifying infective foci within the heart and extracardiac locations. Early utilization of these scans is crucial for confirming or ruling out IE, although caution is required to mitigate false positive responses, especially in the presence of ongoing inflammatory activity. A standardized ratio of ≥2.0 between FDG uptake around infected tissues and the blood pool has demonstrated a sensitivity of 100 % and specificity of 91 %. It is noteworthy that the sensitivity of FDG PET/CT varies, being lower for native valve and lead infections but considerably higher for prosthetic valve and pulse generator infections. This review provides a comprehensive overview of the advantages offered by FDG PET/CT in achieving a definitive diagnosis of IE.
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Affiliation(s)
- I Sathyamurthy
- Dept of Cardiology, Apollo Main Hospitals, Chennai 600006, India.
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Tamaki N, Manabe O. Current status and perspectives of nuclear cardiology. Ann Nucl Med 2024; 38:20-30. [PMID: 37891375 DOI: 10.1007/s12149-023-01878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Nuclear cardiology has long been used to identify myocardial ischemia for appropriate treatment strategies for stable coronary artery disease (CAD). After the Ischemia Trial, it is time to reevaluate the significance of ischemia assessment. Functional imaging continues to play pivotal role in detecting microcirculatory disturbances. PET provides a clear image of blood flow distribution and is useful for the quantitative evaluation of myocardial flow reserve (MFR), which plays an important role in predicting treatment strategies and improving prognosis in CAD. Heart failure has become a major area of focus in cardiovascular medicine. Radionuclide imaging has been widely applied in this field. FDG PET is useful in identifying cardiac sarcoidosis and active inflammation. Clinical values of I-123 MIBG and BMIPP SPECT have been reported worldwide from Japan. Additionally, clinical experiences of Tc-99m pyrophosphate imaging have recently gained attention for assessing cardiac amyloidosis. Cardiac PET/CT and PET/MR imaging permit combined assessment of metabolic/functional/structural analyses of various cardiac diseases. While other non-invasive imaging modalities have rapidly been developed, the roles of radionuclide imaging remain to be valuable for early and accurate diagnosis and patient management in most cases of chronic CAD and various cardiovascular diseases.
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Affiliation(s)
- Nagara Tamaki
- Kyoto College of Medical Science, Kyoto, Japan.
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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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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Hugues B, Emsen B, Pina Vegas L, Lepeule R, Ternacle J, Huguet R, Decousser JW, Fiore A, Lim P, Itti E, Chevalier X, Abulizi M, Eymard F. PET/CT for osteoarticular septic grafts in endocarditis: A large monocentric cohort. Joint Bone Spine 2023; 90:105577. [PMID: 37076094 DOI: 10.1016/j.jbspin.2023.105577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Benjamin Hugues
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Berivan Emsen
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Laura Pina Vegas
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Raphaël Lepeule
- AP-HP, Henri-Mondor Hospital, Department of Microbiology, 94000 Créteil, France
| | - Julien Ternacle
- CHU de Bordeaux, Haut-Lévêque Hospital, Department of Cardiology, 33600 Pessac, France
| | - Raphaëlle Huguet
- AP-HP, Henri-Mondor Hospital, Department of Cardiology, 94000 Créteil, France
| | | | - Antonio Fiore
- AP-HP, Henri-Mondor Hospital, Department of Thoracic Surgery, 94000 Créteil, France
| | - Pascal Lim
- AP-HP, Henri-Mondor Hospital, Department of Cardiology, 94000 Créteil, France
| | - Emmanuel Itti
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Xavier Chevalier
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Mukedaizi Abulizi
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Florent Eymard
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
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Roy SG, Akhtar T, Bandyopadhyay D, Ghosh RK, Hagau R, Ranjan P, Gerard P, Jain D. The Emerging Role of FDG PET/CT in Diagnosing Endocarditis and Cardiac Device Infection. Curr Probl Cardiol 2023; 48:101510. [PMID: 36402219 DOI: 10.1016/j.cpcardiol.2022.101510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Infective endocarditis and cardiac implantable electronic device infection (CIEDI) have witnessed an increasing incidence in clinical practice and associated with increasing health care expenditure. Expanding indications of CIED in various cardiovascular conditions have also contributed to the surge of these infections. Early diagnosis of these infections is associated with a favorable prognosis. Given the lack of a single definitive diagnostic method and the limitations of echocardiography, which is considered a central diagnostic imaging modality, additional imaging modalities are required. Recent studies have highlighted the diagnostic utility of FDG PET and CT. In this review article, we discuss the existing limitations of echocardiography, acquisition protocols of PET/CT, and indications of these advanced imaging modalities in infective endocarditis and CIEDI diagnosis.
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Affiliation(s)
- Shambo Guha Roy
- Division of radiology, Mercy Catholic Medical Center, Darby, PA
| | - Tauseef Akhtar
- Division of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA.
| | | | - Raktim K Ghosh
- MedStar Heart and Vascular Institute, Union Memorial Hospital, Baltimore, MD
| | - Radu Hagau
- Division of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA
| | - Pragya Ranjan
- Division of Cardiology, New York Medical College at Westchester Medical Center, New York, NY
| | - Perry Gerard
- Division of Cardiology, New York Medical College at Westchester Medical Center, New York, NY
| | - Diwakar Jain
- Division of Cardiology, New York Medical College at Westchester Medical Center, New York, NY
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Abstract
The use of positron emission tomography imaging with 18F-fluorodeoxyglucose in the diagnostic workup of patients with suspected prosthetic valve endocarditis and cardiac device infection (implantable electronic device and left ventricular assist device) is gaining momentum in clinical practice. However, in the absence of prospective randomized trials, guideline recommendations about 18F-fluorodeoxyglucose positron emission tomography in this setting are currently largely based on expert opinion. Measurement of aortic valve microcalcification occurring as a healing response to valvular inflammation using 18F-sodium fluoride positron emission tomography represents another promising clinical approach, which is associated with both the risk of native valve stenosis progression and bioprosthetic valve degeneration in research trials. In this review, we consider the role of molecular imaging in cardiac valvular diseases, including aortic stenosis and valvular endocarditis, as well as cardiac device infections.
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Affiliation(s)
- Jason M Tarkin
- Heart and Lung Research Institute, University of Cambridge, UK (J.M.T.)
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD (W.C., V.D.)
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, UK (M.R.D.)
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, MD (W.C., V.D.)
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Rogiers M, Jentjens S, Guler I, Shakoor A, Herregods MC. Value of 18F-FDG pet/CT for prognostic assessment in patients with infective endocarditis. Acta Cardiol 2022; 77:900-909. [PMID: 35172690 DOI: 10.1080/00015385.2022.2040823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND 18F-FDG PET/CT is a valuable diagnostic tool in infective endocarditis (IE). However, the prognostic value is unclear. This study aims to evaluate the prognostic performance of 18F-FDG PET/CT in native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). METHODS We retrospectively included 76 patients treated for definite IE (NVE and PVE) that underwent 18F-FDG PET/CT between January 2016 and December 2018. Clinical, echocardiographic and 18F-FDG PET/CT (pathologic valvular 18F-FDG uptake, extracardiac complications (ECC)) data were collected. The primary endpoint was defined as mortality or recurrence of IE at a one-year follow-up. RESULTS Pathologic valvular 18F-FDG uptake was detected in 32 of 57 (56.1%) patients, 30% (9/30) in NVE and 85.2% (23/27) in PVE group. Atrial fibrillation (OR 3.90, 95% CI = 1.14-16.3), prior anticoagulation treatment (OR 6.37, 95% CI = 1.89-26.7), large vegetation (≥ 10 mm) (OR 4.05, 95% CI = 1.14-16.1), perivalvular complications (OR 7.22, 95% CI = 1.68-55.1) and abscess (OR 10.9, 95% CI = 1.84-283) were associated with positive PET/CT. Extracardiac complications were found in 27 of 76 (35.5%) patients, 42.9% (18/42) in the NVE and 26.5% (9/34) in the PVE group. Pathological valvular tracer uptake (HR 1.20, 95% CI = 0.43-3.37) or extracardiac complications (HR 0.58, 95% CI = 0.21-1.62) were not associated with the occurrence of the primary endpoint. CONCLUSION Our study could not demonstrate a prognostic value of 18F-FDG PET/CT in IE, but confirms high diagnostic performance, which may compromise prognostic significance by accelerated optimal treatment because of earlier diagnostic certainty.
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Affiliation(s)
- Martijn Rogiers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sander Jentjens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Ipek Guler
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Abdul Shakoor
- Department of Internal Medicine, Cardiology, University Hospital Oldenburg, Oldenburg, Germany
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Ghanem-Zoubi N. FDG PET/CT in Cardiac Infection: Does It Matter? A Narrative Review. Infect Dis Ther 2022; 11:1769-1777. [PMID: 35913678 DOI: 10.1007/s40121-022-00679-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
The limited performance of echocardiography in specific infectious processes involving the heart led to the search for additional diagnostic tools. Fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) has been proposed for its diagnostic abilities in several infectious diseases including cardiac infections. A literature review of studies evaluating FDG PET/CT in native valve infective endocarditis (IE), prosthetic valve IE, cardiac implantable electrical device (CIED) infection, and left ventricular assist device (LVAD) infection is presented, focusing on studies published in recent years. Overall, in prosthetic valve endocarditis (PVE), FDG PET/CT demonstrate high sensitivity (73-93%) and specificity (80-95%), while in native valve endocarditis (NVE) the sensitivity is very low (22-68%), with high specificity (97-100%) similar to PVE. For CIED, LVAD infection, and transcatheter aortic valve implantation associated endocarditis, data come from small studies and show good diagnostic performance of FDG PET/CT. International guidelines are increasingly recommending FDG PET/CT for the diagnosis of specific conditions of cardiac infections. Beyond the diagnostic performance ability, few studies have evaluated the added benefit of FDG PET/CT in terms of clinical outcomes of patients with suspected cardiac infection. This should be the focus in future studies.
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Affiliation(s)
- Nesrin Ghanem-Zoubi
- Infectious Diseases Institute, Rambam Health Care Campus, Ha-Aliya 8 St, 3109601, Haifa, Israel. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
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Eder MD, Upadhyaya K, Park J, Ringer M, Malinis M, Young BD, Sugeng L, Hur DJ. Multimodality Imaging in the Diagnosis of Prosthetic Valve Endocarditis: A Brief Review. Front Cardiovasc Med 2022; 8:750573. [PMID: 34988125 PMCID: PMC8720921 DOI: 10.3389/fcvm.2021.750573] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/29/2021] [Indexed: 12/17/2022] Open
Abstract
Infective endocarditis is a common and treatable condition that carries a high mortality rate. Currently the workup of infective endocarditis relies on the integration of clinical, microbiological and echocardiographic data through the use of the modified Duke criteria (MDC). However, in cases of prosthetic valve endocarditis (PVE) echocardiography can be normal or non-diagnostic in a high proportion of cases leading to decreased sensitivity for the MDC. Evolving multimodality imaging techniques including leukocyte scintigraphy (white blood cell imaging), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), multidetector computed tomographic angiography (MDCTA), and cardiac magnetic resonance imaging (CMRI) may each augment the standard workup of PVE and increase diagnostic accuracy. While further studies are necessary to clarify the ideal role for each of these imaging techniques, nevertheless, these modalities hold promise in determining the diagnosis, prognosis, and care of PVE. We start by presenting a clinical vignette, then evidence supporting various modality strategies, balanced by limitations, and review of formal guidelines, when available. The article ends with the authors' summary of future directions and case conclusion.
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Affiliation(s)
- Maxwell D Eder
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Krishna Upadhyaya
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States.,Ascension Medical Group, Section of Cardiovascular Medicine, Milwaukee, WI, United States
| | - Jakob Park
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, United States
| | - Matthew Ringer
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Maricar Malinis
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Bryan D Young
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - David J Hur
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
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11
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Mikail N, Hyafil F. Nuclear Imaging in Infective Endocarditis. Pharmaceuticals (Basel) 2021; 15:ph15010014. [PMID: 35056069 PMCID: PMC8777992 DOI: 10.3390/ph15010014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease with stable prevalence despite prophylactic, diagnostic, and therapeutic advances. In parallel to the growing number of cardiac devices implanted, the number of patients developing IE on prosthetic valves and cardiac implanted electronic device (CIED) is increasing at a rapid pace. The diagnosis of IE is particularly challenging, and currently relies on the Duke-Li modified classification, which include clinical, microbiological, and imaging criteria. While echocardiography remains the first line imaging technique, especially in native valve endocarditis, the incremental value of two nuclear imaging techniques, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) and white blood cells single photon emission tomography with computed tomography (WBC-SPECT), has emerged for the management of prosthetic valve and CIED IE. In this review, we will summarize the procedures for image acquisition, discuss the role of 18F-FDG-PET/CT and WBC-SPECT imaging in different clinical situations of IE, and review the respective diagnostic performance of these nuclear imaging techniques and their integration into the diagnostic algorithm for patients with a suspicion of IE.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110 Clichy, France;
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8006 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952 Schlieren, Switzerland
| | - Fabien Hyafil
- Department of Nuclear Medicine, Georges-Pompidou European Hospital, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, 20 Rue Leblanc, 75015 Paris, France
- Correspondence: ; Tel.: +33-01-56-09-56-24
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12
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Anton-Vazquez V, Cannata A, Amin-Youssef G, Watson S, Fife A, Mulholland N, Gunning M, Papachristidis A, MacCarthy P, Baghai M, Deshpande R, Khan H, Byrne J, Dworakowski R. Diagnostic value of 18F-FDG PET/CT in infective endocarditis. Clin Res Cardiol 2021; 111:673-679. [PMID: 34821999 DOI: 10.1007/s00392-021-01975-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) is not routinely recommended for the diagnosis of infective endocarditis (IE) due to the lack of clinical impact. MATERIALS AND METHODS Between January 2016 and January 2020, clinical data from patients with a possible diagnosis of IE were reviewed retrospectively to evaluate the value of 18F-FDG-PET/CT in the diagnosis of IE. 18F-FDG PET/CT scan was performed as an additional diagnostic tool in possible IE when echocardiography was inconclusive or in patients with definite IE to identify extracardiac complications. Cases were classified according to modified Duke criteria as rejected, definite or possible. RESULTS 313 patients with suspected IE were included. 72 (23%) patients underwent 18F-FDG PET/CT. 18F-FDG PET/CT resulted in a reclassification of Duke criteria in 29/72 (40%) patients, from "possible" to "definite" (n, 10) and to "rejected" (n, 19). Patients who benefited from a Duke criteria reclassification following 18F-FDG PET/CT were more frequently classified as possible IE at inclusion or had a non-conclusive baseline echocardiography (100% vs 58%; p 0.001) and had more likely a prosthetic metallic valve replacement (59% vs 21%; p 0.001). Abnormal perivalvular uptake was identified in 46 patients (71% prosthetic vs 50% native; p 0.118). 18F-FDG PET/CT identified extracardiac uptake consistent with septic emboli in 14/72 (19%) patients. In addition, extracardiac uptake indicative of an alternative diagnosis was identified in 5 patients (2% prosthetic vs 17% native; p 0.039). CONCLUSION The use of 18F-FDG-PET/CT has shown to be useful in the diagnosis of IE, particularly in prosthetic IE and may provide additional value in the detection of septic emboli and/or the identification of an alternative diagnosis different from IE.
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Affiliation(s)
- Vanesa Anton-Vazquez
- Department of Infectious Diseases and Medical Microbiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Antonio Cannata
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - George Amin-Youssef
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Samuel Watson
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Amanda Fife
- Department of Infectious Diseases and Medical Microbiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Nicola Mulholland
- Department of Nuclear Medicine, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Margaret Gunning
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Alexandros Papachristidis
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Phil MacCarthy
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Max Baghai
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Ranjit Deshpande
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Habib Khan
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Jonathan Byrne
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.,Honorary Senior Clinical Lecturer, Kings College London, London, UK.,1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
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13
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Duval X, Le Moing V, Tubiana S, Esposito-Farèse M, Ilic-Habensus E, Leclercq F, Bourdon A, Goehringer F, Selton-Suty C, Chevalier E, Boutoille D, Piriou N, Le Tourneau T, Chirouze C, Seronde MF, Morel O, Piroth L, Eicher JC, Humbert O, Revest M, Thébault E, Devillers A, Delahaye F, Boibieux A, Grégoire B, Hoen B, Laouenan C, Iung B, Rouzet F. Impact of Systematic Whole-body 18F-Fluorodeoxyglucose PET/CT on the Management of Patients Suspected of Infective Endocarditis: The Prospective Multicenter TEPvENDO Study. Clin Infect Dis 2021; 73:393-403. [PMID: 32488236 DOI: 10.1093/cid/ciaa666] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/27/2020] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Xavier Duval
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France
| | - Vincent Le Moing
- Department of Infectious Diseases, University Hospital of Montpellier, Montpellier, France
| | - Sarah Tubiana
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France
| | - Marina Esposito-Farèse
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,Unité de Recherche Clinique, AP-HP, HUPNVS, Hôpital Universitaire Paris Nord-Val de Seine, Paris, France
| | - Emila Ilic-Habensus
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France
| | - Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, Montpellier, France
| | - Aurélie Bourdon
- Department of Nuclear Medicine, University Hospital of Montpellier, Montpellier, France
| | - François Goehringer
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | | | - Elodie Chevalier
- Department of Nuclear Medicine, University Hospital of Nancy, Nancy, France
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital of Nantes, Nantes, France
| | - Nicolas Piriou
- Thorax Institute, INSERM, UMR 1087, University Hospital of Nantes, Nantes, France.,Department of Nuclear Medicine, Nantes University Hospital, G. et R. Laennec Hospital, Nantes, France
| | - Thierry Le Tourneau
- Thorax Institute, INSERM, UMR 1087, University Hospital of Nantes, Nantes, France
| | - Catherine Chirouze
- University Hospital of Besançon, France, UMR CNRS 6249 Chrono-Environnement, Bourgogne University, Franche-Comté, Dijon, France
| | | | - Olivier Morel
- Department of Nuclear Medicine, University Hospital of Besançon, Besançon, France
| | - Lionel Piroth
- Department of Infectious Diseases, University Hospital of Dijon, INSERM CIC 1432, CHU Dijon, France
| | | | - Olivier Humbert
- Department of Nuclear Medicine, University Hospital of Dijon, Dijon, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, University Hospital of Rennes France, INSERM U1230 CHU Rennes, France.,INSERM CIC 1414, University Hospital of Rennes, France
| | | | - Anne Devillers
- Department of Nuclear Medicine, University Hospital of Rennes, France
| | | | - André Boibieux
- Department of Nuclear Medicine, University Hospital of Lyon, Lyon, France
| | - Bastien Grégoire
- Department of Infectious Diseases, University Hospital of Lyon, Lyon, France
| | - Bruno Hoen
- Department of Infectious Diseases, University Hospital of Nancy, Nancy, France
| | - Cédric Laouenan
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France.,Unité de Recherche Clinique, AP-HP, HUPNVS, Hôpital Universitaire Paris Nord-Val de Seine, Paris, France
| | - Bernard Iung
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France
| | - François Rouzet
- INSERM CIC 1425, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,INSERM UMR-1137 IAME, Paris, France.,University Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France.,Department of Nuclear Medicine, AP-HP, University Hospital of Bichat, Paris, France
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14
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Infective endocarditis - A review of current therapy and future challenges. Hellenic J Cardiol 2020; 62:190-200. [PMID: 33176209 DOI: 10.1016/j.hjc.2020.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
Etiological, microbiological and epidemiological factors changed over time, but mortality rates remain high in infective endocarditis (IE). Healthcare-associated IE is nowadays responsible for a significant proportion of cases due to increasing numbers of cardiac devices. Cardiac implantable electronic devices, transcatheter aortic valve replacement, and percutaneous valve repair are meanwhile used, especially in old and sick patients. In suspected IE modified Duke criteria, integrating clinical results, imaging, and biomarkers are traditionally applied. Newer imaging technologies such as multi-slice computed tomography, photon-emission computed tomography, and magnetic resonance imaging might add value to conventional echocardiography in diagnosis and management of IE. Treatment consists of long-term antibiotic therapy, infectiological source control and/or cardiac surgery. Recently, antibiotic parenteral outpatient regimens and partial oral treatment strategies were shown to shorten hospital stays in patients suffering from IE. However, it remains unclear how to best select patients for partial oral therapy. This review describes new trends in diagnosing, imaging, and treating IE in a changing patient collective with particular focus on patients with implantable cardiac devices.
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15
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Kong E. F-18 fluorodeoxyglucose positron emission tomography/computed tomography in the infection of heart. Yeungnam Univ J Med 2020; 38:95-106. [PMID: 33053614 PMCID: PMC8016625 DOI: 10.12701/yujm.2020.00479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023] Open
Abstract
Infections involving the heart are becoming increasingly common, and a timely diagnosis of utmost importance, despite its challenges. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently introduced diagnostic tool in cardiology. This review focuses on the current evidence for the use of FDG PET/CT in the diagnosis of infective endocarditis, cardiac implantable device infection, left ventricular assist device infection, and secondary complications. The author discusses considerations when using FDG PET/CT in routine clinical practice, patient preparation for reducing physiologic myocardial uptake, acquisition of images, and interpretation of PET/CT findings. This review also functions to highlight the need for a standardized acquisition protocol.
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Affiliation(s)
- Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu, Korea
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16
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Lecomte R, Issa N, Gaborit B, Le Turnier P, Deschanvres C, Asseray N, Le Tourneau T, Michel M, Al Habash O, Bizouarn P, Camou F, Boutoille D. Risk-benefit Assessment of Systematic Thoracoabdominal-pelvic Computed Tomography in Infective Endocarditis. Clin Infect Dis 2020; 69:1605-1612. [PMID: 30615098 DOI: 10.1093/cid/ciz014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the management of infective endocarditis (IE), the presence of extracardiac complications has an influence on both diagnosis and treatment. Current guidelines suggest that systematic thoracoabdominal-pelvic computed tomography (TAP-CT) may be helpful. Our objective was to describe how systematic TAP-CT affects the diagnosis and the management of IE. METHODS In this multicenter cohort study, between January 2013 and July 2016 we included consecutive patients who had definite or possible IE according to the Duke modified criteria, validated by endocarditis teams. We analyzed whether the Duke classification and therapeutic management were modified regarding the presence or the absence of IE-related lesion on CT and investigated the tolerance of this examination. RESULTS Of the 522 patients included in this study, 217 (41.6%) had 1 or more IE-related lesions. On the basis of CT results in asymptomatic patients, diagnostic classification was upgraded from possible endocarditis to definite endocarditis for only 4 cases (0.8%). The presence of IE-related lesions on CT did not modify the duration of antibiotic treatment (P = .55), nor the decision of surgical treatment (P = .39). Specific treatment of the lesion was necessary in 42 patients (8.0%), but only 9 of these lesions (1.9%) were asymptomatic and diagnosed only on the TAP-CT. Acute kidney injury (AKI) within 5 days of CT was observed in 78 patients (14.9%). CONCLUSIONS The TAP-CT findings slightly affected diagnosis and treatment of IE in a very small proportion of asymptomatic patients. Furthermore, contrast media should be used with caution because of the high risk of AKI.
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Affiliation(s)
- Raphaël Lecomte
- Department of Infectious Disease, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu.,Centre d'Investigation Clinique Unité d'Investigation Clinique 1413 Institut national de la santé et de la recherche médicale, CHU Nantes
| | - Nahéma Issa
- Intensive Care and Infectious Disease Unit, Groupe Saint-André, CHU Bordeaux
| | - Benjamin Gaborit
- Department of Infectious Disease, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu.,Centre d'Investigation Clinique Unité d'Investigation Clinique 1413 Institut national de la santé et de la recherche médicale, CHU Nantes
| | - Paul Le Turnier
- Department of Infectious Disease, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu.,Centre d'Investigation Clinique Unité d'Investigation Clinique 1413 Institut national de la santé et de la recherche médicale, CHU Nantes
| | - Colin Deschanvres
- Department of Infectious Disease, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu.,Centre d'Investigation Clinique Unité d'Investigation Clinique 1413 Institut national de la santé et de la recherche médicale, CHU Nantes
| | - Nathalie Asseray
- Department of Infectious Disease, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu.,Centre d'Investigation Clinique Unité d'Investigation Clinique 1413 Institut national de la santé et de la recherche médicale, CHU Nantes
| | | | - Magali Michel
- Department of Cardiology, University Hospital, Nantes, France
| | - Ousama Al Habash
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France
| | | | - Fabrice Camou
- Intensive Care and Infectious Disease Unit, Groupe Saint-André, CHU Bordeaux
| | - David Boutoille
- Department of Infectious Disease, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu.,Centre d'Investigation Clinique Unité d'Investigation Clinique 1413 Institut national de la santé et de la recherche médicale, CHU Nantes
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17
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Manabe O, Naya M, Aikawa T, Tamaki N. Recent advances in cardiac positron emission tomography for quantitative perfusion analyses and molecular imaging. Ann Nucl Med 2020; 34:697-706. [DOI: 10.1007/s12149-020-01519-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022]
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18
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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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19
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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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20
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Clinical usefulness of FDG-PET/CT for identification of abnormal extra-cardiac foci in patients with infective endocarditis. Int J Cardiovasc Imaging 2020; 36:939-946. [PMID: 32060776 DOI: 10.1007/s10554-020-01787-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/31/2020] [Indexed: 02/03/2023]
Abstract
The aim of the study was to evaluate the ability to detect extra-cardiac foci by means of whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with definite endocarditis (IE) according to the modified Duke criteria and investigate the clinical impact of the findings. From January 2011 to December 2015 we included 178 patients (mean age 66 ± 14 years, 25% female) with IE in this multicentre study. FDG-PET/CT was part of the work-up for extra-cardiac foci in the including hospitals and was performed at a median of 9 days (IQR 10) after IE was diagnosed. In 114 patients FDG-PET/CT identified 166 lesions: 52 (31%) infectious lesions, 21 (13%) cases of cancer, 7 (4%) cases of embolism, 60 (36%) reactive findings, and 26 (16%) other types of lesions. A total of 74 new extra-cardiac findings, not previously discovered by other modalities, were identified in 62 patients and resulted in additional investigations in 29 patients and a change in treatment in 18 patients (10%). The most frequent diagnoses discovered by FDG-PET/CT were colon polyps, cancer, and spondylodiscitis. There was a higher rate of findings leading to a change in treatment in patients above 67 years of age infected with other bacterial aetiologies than streptococci. FDG-PET/CT was useful to detect extra-cardiac foci. FDG-PET/CT findings may lead to unnecessary investigations. One out of 10 the patients with definite endocarditis had underwent a change in treatment regimen based on the FDG-PET/CT findings.
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21
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Rezar R, Jirak P, Lichtenauer M, Jung C, Lauten A, Hoppe UC, Wernly B. Partial oral antibiotic therapy is non-inferior to intravenous therapy in non-critically ill patients with infective endocarditis : Review and meta-analysis. Wien Klin Wochenschr 2020; 132:762-769. [PMID: 32040621 PMCID: PMC7732798 DOI: 10.1007/s00508-020-01614-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/22/2020] [Indexed: 12/02/2022]
Abstract
Background Antimicrobial therapy is a cornerstone in the treatment of infective endocarditis (IE). Typically, intravenous (i.v.) therapy is given for 6 weeks or longer, leading to prolonged hospital stays and high costs. Several trials evaluating the efficacy of partial oral therapy (POT) have been published. This article aimed to review and meta-analyze studies comparing i.v. therapy versus POT in non-critically ill patients suffering from IE. Methods A structured database search (based on PRISMA guidelines) regarding POT versus i.v. therapy in IE was conducted using PubMed/Medline. Primary endpoint was all-cause mortality and a secondary endpoint IE relapse. Risk rates were calculated using a random effects model (DerSimonian and Laird). Heterogeneity was assessed using the I2 statistics. Results After screening 1848 studies at title and abstract levels, 4 studies were included. A total of 765 patients suffered from primary left-sided IE, whereas right-sided IE was observed in 72 patients. Mortality rates were lower in POT versus i.v. therapy (risk ratio [RR] 0.38, 95% confidence interval, confidence interval [CI] 0.20–0.74; p = 0.004; I2 0%). IE relapse rates were similar (RR 0.63, 95% CI 0.29–1.37; p = 0.24; I2 0%). Conclusion Data comparing POT with standard care in IE is limited and to date only one sufficiently powered stand-alone trial exists to support its use. In this meta-analysis POT was non-inferior to i.v. therapy with respect to mortality and IE relapse in non-critically ill patients suffering from both left-sided and right-sided IE. These findings indicate that POT is a feasible treatment strategy in selected patients suffering from IE but further validation in future studies will be required.
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Affiliation(s)
- Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Peter Jirak
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Alexander Lauten
- Department of Cardiology, University Heart Center Charité Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
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22
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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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23
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Mahmood M, Kendi AT, Ajmal S, Farid S, O'Horo JC, Chareonthaitawee P, Baddour LM, Sohail MR. Meta-analysis of 18F-FDG PET/CT in the diagnosis of infective endocarditis. J Nucl Cardiol 2019; 26:922-935. [PMID: 29086386 DOI: 10.1007/s12350-017-1092-8] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The current diagnosis of infective endocarditis (IE) is based on the modified Duke criteria, which has approximately 80% sensitivity for the diagnosis of native valve endocarditis (NVE), with lower sensitivity for the diagnosis of prosthetic valve endocarditis (PVE) and culture-negative endocarditis. There is preliminary evidence that 18F-FDG PET/CT is an adjunctive diagnostic test with high accuracy reported in small studies to date. We therefore performed a meta-analysis of studies evaluating the use of PET/CT in the diagnosis of IE to establish a more precise estimate of accuracy. METHODS PubMed, Embase, Cochrane library, CINAHL, Web of Knowledge, and www.clinicaltrials.gov were searched from January 1990 to April 2017 for studies evaluating the accuracy of PET/CT for the evaluation of possible IE. RESULTS We identified 13 studies involving 537 patients that were included in the meta-analysis. The pooled sensitivity of PET/CT for diagnosis of IE was 76.8% (95% CI 71.8-81.4%; Q = 39.9, P < 0.01; I2 = 69.9%) and the pooled specificity was 77.9% (95% CI 71.9-83.2%; Q = 44.42, P < 0.01; I2 = 73.0%). Diagnostic accuracy was improved for PVE with sensitivity of 80.5% (95% CI 74.1-86.0%; Q = 25.5, P < 0.01; I2 = 72.5%) and specificity of 73.1% (95% CI 63.8-81.2%; Q = 32.1, P < 0.01; I2 = 78.2%). Additional extracardiac foci of infection were found on 17% of patients on whole body PET/CT. CONCLUSION PET/CT is a useful adjunctive diagnostic tool in the evaluation of diagnostically challenging cases of IE, particularly in prosthetic valve endocarditis. It also has the potential to detect clinically relevant extracardiac foci of infection, malignancy, and other sources of inflammation leading to more appropriate treatment regimens and surgical intervention.
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Affiliation(s)
- Maryam Mahmood
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Ayse Tuba Kendi
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Saira Ajmal
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Saira Farid
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA
| | - John C O'Horo
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Medicine, 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, 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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24
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Saraste A, Knuuti J. Guidelines in review: Comparison of ESC and AHA guidance for the diagnosis and management of infective endocarditis in adults. Are the differences clinically relevant? The European perspective. J Nucl Cardiol 2019; 26:309-312. [PMID: 30132186 DOI: 10.1007/s12350-018-1414-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
- Heart Center, Turku University Hospital, Hämeentie 11, 20520, Turku, Finland.
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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25
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Merits of FDG PET/CT and Functional Molecular Imaging Over Anatomic Imaging With Echocardiography and CT Angiography for the Diagnosis of Cardiac Device Infections. JACC Cardiovasc Imaging 2018; 11:1679-1691. [DOI: 10.1016/j.jcmg.2018.08.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 12/19/2022]
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26
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18F-FDG-PET/CT Imaging to Diagnose Septic Emboli and Mycotic Aneurysms in Patients with Endocarditis and Cardiac Device Infections. Curr Cardiol Rep 2018; 20:14. [PMID: 29511975 DOI: 10.1007/s11886-018-0956-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW This review analyzes recent studies evaluating the diagnostic value of 18F-FDG-PET/CT for the detection of peripheral emboli and secondary infectious foci in patients with infective endocarditis and cardiac device infections. RECENT FINDINGS Detection of extracardiac septic localizations in patients with infective endocarditis and cardiac device infections is crucial, as it may impact the diagnosis, prognosis, and therapeutic management. Recent literature substantiated the clinical usefulness of 18F-FDG-PET/CT in this setting. 18F-FDG-PET/CT has proven its high diagnostic value for the detection of peripheral emboli in patients with infective endocarditis and cardiac device infections, substantially affecting patients' outcome and treatment. A multimodal approach, combining the high sensitivity of 18F-FDG-PET/CT with morphological imaging seems promising.
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27
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Hoerr V, Franz M, Pletz MW, Diab M, Niemann S, Faber C, Doenst T, Schulze PC, Deinhardt-Emmer S, Löffler B. S. aureus endocarditis: Clinical aspects and experimental approaches. Int J Med Microbiol 2018. [PMID: 29526448 DOI: 10.1016/j.ijmm.2018.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease, caused by septic vegetations and inflammatory foci on the surface of the endothelium and the valves. Due to its complex and often indecisive presentation the mortality rate is still about 30%. Most frequently bacterial microorganisms entering the bloodstream are the underlying origin of the intracardiac infection. While the disease was primarily restricted to younger patients suffering from rheumatic heart streptococci infections, new at risk categories for Staphylococcus (S.) aureus infections arose over the last years. Rising patient age, increasing drug resistance, intensive treatment conditions such as renal hemodialysis, immunosuppression and long term indwelling central venous catheters but also the application of modern cardiac device implants and valve prosthesis have led to emerging incidences of S. aureus IE in health care settings and community. The aetiologic change has impact on the pathophysiology of IE, the clinical presentation and the overall patient management. Despite intensive research on appropriate in vitro and in vivo models of IE and gained knowledge about the fundamental mechanisms in the formation of bacterial vegetations and extracardiac complications, improved understanding of relevant bacterial virulence factors and triggered host immune responses is required to help developing novel antipathogenic treatment strategies and pathogen specific diagnostic markers. In this review, we summarize and discuss the two main areas affected by the changing patient demographics and provide first, recent knowledge about the pathogenic strategies of S. aureus in the induction of IE, including available experimental models of IE used to study host-pathogen interactions and diagnostic and therapeutic targets. In a second focus we present diagnostic (imaging) regimens for patients with S. aureus IE according to current guidelines as well as treatment strategies and surgical recommendations.
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Affiliation(s)
- V Hoerr
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - M Franz
- Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - M Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - S Niemann
- Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany
| | - C Faber
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A16, 48149 Münster, Germany
| | - T Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - P C Schulze
- Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - S Deinhardt-Emmer
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - B Löffler
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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28
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Sohns JM, Bavendiek U, Ross TL, Bengel FM. Targeting Cardiovascular Implant Infection: Multimodality and Molecular Imaging. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.005376. [PMID: 29222120 DOI: 10.1161/circimaging.117.005376] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Owing to their success in clinical practice, the prevalence of cardiovascular implants is continuously increasing. Implant infection is a relevant complication but remains a diagnostic challenge because echocardiography as a first-line test may be limited. Accordingly, a multimodality approach is increasingly used for diagnostic workup and supported by recent guidelines. As reviewed here, computed tomography and nuclear imaging provide incremental diagnostic value and may be combined in a single hybrid imaging session using positron emission tomography/computed tomography or single photon emission computed tomography/computed tomography. Molecular or cellular imaging helps to overcome the limitations of morphological imaging in implants. Larger-scale clinical studies, earlier application in the time course of diagnosis, monitoring of therapy success, technical advances, and novel radiopharmaceuticals will all contribute to sustained growth of advanced infection-targeted imaging in cardiovascular medicine.
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Affiliation(s)
- Jan M Sohns
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany
| | - Udo Bavendiek
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany
| | - Tobias L Ross
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany
| | - Frank M Bengel
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany.
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29
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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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30
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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. [PMID: 28807509 DOI: 10.1016/j.ijcard.2017.08.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/21/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of 18F-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients' complex anatomy. METHODS A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (≥18years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC+PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. RESULTS Between November-2012 and April-2017, 25 patients (15 men; median age 40years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC+PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. CONCLUSIONS PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification.
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Abstract
PET/computed tomography (CT) can evaluate the metabolic and anatomic involvement of a variety of inflammatory, infectious, and malignant cardiovascular disorders. PET/CT is useful in evaluating coronary vasculature, hibernating myocardium, cardiac sarcoidosis, cardiac amyloidosis, cerebrovascular disease, acute aortic syndromes, cardiac and vascular neoplasms, cardiac and vascular infections, and vasculitis. Novel targeted radiopharmaceutical agents and novel use of established techniques show promise in diagnosing and monitoring cardiovascular diseases.
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Affiliation(s)
- Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
| | - Don C Yoo
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
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32
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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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Abstract
PURPOSE OF REVIEW This review analyzes recent studies evaluating the diagnostic and therapeutic impacts of systematic extracardiac imaging techniques in patients with suspected or proven infective endocarditis. RECENT FINDINGS Extracardiac imaging techniques are more and more frequently used to establish infective endocarditis (IE) diagnosis in doubtful situations. They also help in evaluating the risk-benefit balance of therapeutic strategies and particularly valvular surgery which is performed in approximately 50% of patients. Latest research underlines the high frequency of asymptomatic lesions found, and a different advantage-disadvantage profile for each of these techniques. Extracardiac imaging techniques are helpful in doubtful situations and may be considered in other situations. Their interest for improving patients' prognosis remains to be established.
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34
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Sollini M, Boni R, Antunovic L, Kirienko M, Lazzeri E, Erba PA. The Role of Nuclear Cardiac Imaging in Infective Endocarditis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9421-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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35
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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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Characterization of
18
F-Fluorodeoxyglucose Uptake Pattern in Noninfected Prosthetic Heart Valves. Circ Cardiovasc Imaging 2017; 10:e005585. [DOI: 10.1161/circimaging.116.005585] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 01/12/2017] [Indexed: 01/22/2023]
Abstract
Background—
18
F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been recently acknowledged as a diagnostic tool for prosthetic valve endocarditis, but its specificity is limited by uptake on noninfected valves. The objective of this study was to outline the main features of FDG uptake on PET/CT in patients with noninfected prosthetic heart valve (PHV).
Methods and Results—
Our institution’s PET/CT database was reviewed to identify patients with PHV, excluding those suspected of infection or who had received antibiotic treatment. PET indication, valve location, and type (biological/mechanical) and time from implantation were collected for each patient. Images with and without attenuation correction were considered for interpretation. The pattern of FDG uptake (absent, homogeneous, or heterogeneous) was recorded. Fifty-four PHVs (51 patients) were identified, including 32 biological valves. Indications for PET were oncology (n=26), suspicion of prosthetic valve endocarditis subsequently excluded (n=17), and history of vasculitis (n=11). A periprosthetic FDG uptake was present in 47 (87%) and 30 (56%) PHVs with and without attenuation correction, respectively, and the pattern was homogeneous in all but 4 (7%) and 3 (6%) PHVs, respectively. On quantitative analysis, maximum standardized uptake values was greater in mechanical than in biological valves (4.0 [2.4–8.0] versus 3.3 [2.1–6.1];
P
=0.01) and in patients with vasculitis than in those referred for other indications. The uptake intensity did not differ before and 3 months after valve replacement.
Conclusions—
Noninfected PHVs frequently display homogeneous FDG uptake, which remains steady over time. Caution is, therefore, needed when interpreting FDG PET/CT in suspected prosthetic valve endocarditis, with specific attention to uptake pattern.
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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: 31] [Impact Index Per Article: 4.4] [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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Salomäki SP, Saraste A, Kemppainen J, Bax JJ, Knuuti J, Nuutila P, Seppänen M, Roivainen A, Airaksinen J, Pirilä L, Oksi J, Hohenthal U. 18F-FDG positron emission tomography/computed tomography in infective endocarditis. J Nucl Cardiol 2017; 24:195-206. [PMID: 26662063 DOI: 10.1007/s12350-015-0325-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The diagnosis of infective endocarditis (IE), especially the diagnosis of prosthetic valve endocarditis (PVE) is challenging since echocardiographic findings are often scarce in the early phase of the disease. We studied the use of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in IE. METHODS Sixteen patients with suspected PVE and 7 patients with NVE underwent visual evaluation of 18F-FDG-PET/CT. 18F-FDG uptake was measured also semiquantitatively as maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). The modified Duke criteria were used as a reference. RESULTS There was strong, focal 18F-FDG uptake in the area of the affected valve in all 6 cases of definite PVE, in 3 of 5 possible PVE cases, and in 2 of 5 rejected cases. In all patients with definite PVE, SUVmax of the affected valve was higher than 4 and TBR higher than 1.8. In contrast to PVE, only 1 of 7 patients with NVE had uptake of 18F-FDG by PET/CT in the valve area. Embolic infectious foci were detected in 58% of the patients with definite IE. CONCLUSIONS 18F-FDG-PET/CT appears to be a sensitive method for the detection of paravalvular infection associated with PVE. Instead, the sensitivity of PET/CT is limited in NVE.
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Affiliation(s)
- Soile Pauliina Salomäki
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Pirjo Nuutila
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Marko Seppänen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Juhani Airaksinen
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Laura Pirilä
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
| | - Jarmo Oksi
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Ulla Hohenthal
- Division of Medicine, University of Turku and Turku University Hospital, P.O. Box 52, 20521, Turku, Finland.
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Clinical utility of 18F-FDG positron emission tomography/computed tomography scan vs. 99mTc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis. Int J Cardiovasc Imaging 2017; 33:751-760. [DOI: 10.1007/s10554-016-1047-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
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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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Sarrazin JF, Philippon F, Trottier M, Tessier M. Role of radionuclide imaging for diagnosis of device and prosthetic valve infections. World J Cardiol 2016; 8:534-546. [PMID: 27721936 PMCID: PMC5039355 DOI: 10.4330/wjc.v8.i9.534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/14/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular implantable electronic device (CIED) infection and prosthetic valve endocarditis (PVE) remain a diagnostic challenge. Cardiac imaging plays an important role in the diagnosis and management of patients with CIED infection or PVE. Over the past few years, cardiac radionuclide imaging has gained a key role in the diagnosis of these patients, and in assessing the need for surgery, mainly in the most difficult cases. Both 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and radiolabelled white blood cell single-photon emission computed tomography/computed tomography (WBC SPECT/CT) have been studied in these situations. In their 2015 guidelines for the management of infective endocarditis, the European Society of Cardiology incorporated cardiac nuclear imaging as part of their diagnostic algorithm for PVE, but not CIED infection since the data were judged insufficient at the moment. This article reviews the actual knowledge and recent studies on the use of 18F-FDG PET/CT and WBC SPECT/CT in the context of CIED infection and PVE, and describes the technical aspects of cardiac radionuclide imaging. It also discusses their accepted and potential indications for the diagnosis and management of CIED infection and PVE, the limitations of these tests, and potential areas of future research.
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Pizzi MN, Roque A, Fernández-Hidalgo N, Cuéllar-Calabria H, Ferreira-González I, Gonzàlez-Alujas MT, Oristrell G, Gracia-Sánchez L, González JJ, Rodríguez-Palomares J, Galiñanes M, Maisterra-Santos O, Garcia-Dorado D, Castell-Conesa J, Almirante B, Aguadé-Bruix S, Tornos P. 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. [PMID: 26276890 DOI: 10.1161/circulationaha.115.015316] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 07/13/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The diagnosis of infective endocarditis (IE) in prosthetic valves and intracardiac devices is challenging because both the modified Duke criteria (DC) and echocardiography have limitations in this population. The added value of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) and (18)F-FDG PET/CT angiography (PET/CTA) was evaluated in this complex scenario at a referral center with a multidisciplinary IE unit. METHODS AND RESULTS Ninety-two patients admitted to our hospital with suspected prosthetic valve or cardiac device IE between November 2012 and November 2014 were prospectively included. All patients underwent echocardiography and PET/CT, and 76 had cardiac CTA. PET/CT and echocardiography findings were evaluated and compared, with concordant results in 54% of cases (κ=0.23). Initial diagnoses with DC at admission, PET/CT, and DC+PET/CT were compared with the final diagnostic consensus reached by the IE Unit. DC+PET/CT enabled reclassification of 90% of cases initially classified as possible IE with DC and provided a conclusive diagnosis (definite/rejected) in 95% of cases. Sensitivity, specificity, and positive and negative predictive values were 52%, 94.7%, 92.9%, and 59.7% for DC; 87%, 92.1%, 93.6%, and 84.3% for PET/CT; and 90.7%, 89.5%, 92%, and 87.9% for DC+PET/CT. Use of PET/CTA yielded even better diagnostic performance values than PET/nonenhanced CT (91%, 90.6%, 92.8%, and 88.3% versus 86.4%, 87.5%, 90.2%, and 82.9%) and substantially reduced the rate of doubtful cases from 20% to 8% (P<0.001). DC+PET/CTA reclassified an additional 20% of cases classified as possible IE with DC+PET/nonenhanced CT. In addition, PET/CTA enabled detection of a significantly larger number of anatomic lesions associated with active endocarditis than PET/nonenhanced CT (P=0.006) or echocardiography (P<0.001). CONCLUSIONS (18)F-FDG PET/CT improves the diagnostic accuracy of the modified DC in patients with suspected IE and prosthetic valves or cardiac devices. PET/CTA yielded the highest diagnostic performance and provided additional diagnostic benefits.
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Affiliation(s)
- María N Pizzi
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.).
| | - Albert Roque
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Nuria Fernández-Hidalgo
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Hug Cuéllar-Calabria
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Ignacio Ferreira-González
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - María T Gonzàlez-Alujas
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Gerard Oristrell
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Laura Gracia-Sánchez
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Juan J González
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - José Rodríguez-Palomares
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Manuel Galiñanes
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Olga Maisterra-Santos
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - David Garcia-Dorado
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Joan Castell-Conesa
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Benito Almirante
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Santiago Aguadé-Bruix
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
| | - Pilar Tornos
- From Departments of Cardiology (M.N.P., I.F.-G., M.T.G.-A., G.O., J.R.-P., D.G.-D., P.T.), Radiology (A.R., H.C.-C.), Infectious Diseases (N.-F.H., B.A.), Nuclear Medicine (L.G.-S., J.C.-C., S.A.-B.), Microbiology (J.J.G.), Cardiac Surgery (M.G.), and Neurology (O.M.-S.), Vall d´Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona (M.N.P., N.F.-H., J.R.-P., D.G.-D., J.C.-C., B.A., S.A.-B., P.T.), Spain; and CIBER de Epidemiología y Salud Pública, Madrid, Spain (I.F.G.)
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Edvardsen T, Bucciarelli-Ducci C, Saraste A, Pierard LA, Knuuti J, Maurer G, Habib G, Lancellotti P. The year 2014 in the European Heart Journal - Cardiovascular Imaging. Part I. Eur Heart J Cardiovasc Imaging 2015; 16:712-8. [DOI: 10.1093/ehjci/jev150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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