F-18-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material
Por:
Pizzi, MN, Dos-Subira, L, Roque, A, Fernandez-Hidalgo, N, Cuellar-Calabria, H, Domenech, AP, Gonzalez-Alujas, MT, Subirana-Domenech, MT, Miranda-Barrio, B, Ferreira-Gonzalez, I, Gonzalez-Lopez, JJ, Igual, A, Maisterra-Santos, O, Garcia-Dorado, D, Castell-Conesa, J, Almirante, B, Amores, ME, Tornos, P, Aguade-Bruix, S
Publicada:
1 dic 2017
Resumen:
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 F-18-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 (>= 18 years) 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 40 years) 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. (C) 2017 Elsevier B.V. All rights reserved.
Filiaciones:
Pizzi, MN:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Dos-Subira, L:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Vall Hebron Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
St Pau Univ Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
CIBERCV, Murcia, Spain
Roque, A:
Hosp Univ Vall Hebron, Dept Radiol, Barcelona, Spain
IDI, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Fernandez-Hidalgo, N:
Hosp Univ Vall Hebron, Dept Infect Dis, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Vall Hebron Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
St Pau Univ Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
CIBERCV, Murcia, Spain
REIPI, Seville, Spain
Cuellar-Calabria, H:
Hosp Univ Vall Hebron, Dept Radiol, Barcelona, Spain
IDI, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Domenech, AP:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Vall Hebron Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
St Pau Univ Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
Gonzalez-Alujas, MT:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Subirana-Domenech, MT:
Univ Autonoma Barcelona, Barcelona, Spain
Vall Hebron Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
St Pau Univ Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
Miranda-Barrio, B:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Vall Hebron Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
St Pau Univ Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
Ferreira-Gonzalez, I:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Gonzalez-Lopez, JJ:
Hosp Univ Vall Hebron, Dept Microbiol, Barcelona, Spain
Hosp Univ Vall Hebron, Dept Neurol, Barcelona, Spain
IDI, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Igual, A:
Hosp Univ Vall Hebron, Dept Cardiac Surg, Barcelona, Spain
Maisterra-Santos, O:
Hosp Univ Vall Hebron, Dept Neurol, Barcelona, Spain
Garcia-Dorado, D:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
CIBERCV, Murcia, Spain
Castell-Conesa, J:
Hosp Univ Vall Hebron, Dept Nucl Med, Barcelona, Spain
IDI, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Almirante, B:
Hosp Univ Vall Hebron, Dept Infect Dis, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Vall Hebron Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
St Pau Univ Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain
CIBERCV, Murcia, Spain
REIPI, Seville, Spain
Amores, ME:
Hosp Univ Vall Hebron, Dept Radiol, Barcelona, Spain
IDI, Barcelona, Spain
Tornos, P:
Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Aguade-Bruix, S:
Hosp Univ Vall Hebron, Dept Nucl Med, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
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