Comparison Between ESC and Duke Criteria for the Diagnosis of Prosthetic Valve Infective Endocarditis |
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| Institution: | 1. APHM, La Timone Hospital, Cardiology Department, Marseille, France;2. Department of Nuclear Medicine, La Timone Hospital, Marseille, France;3. Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l''Information Médicale, Marseille, France;4. APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l''Information et de la Communication, Marseille, France;5. Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service de Microbiologie, Unité Mobile d''infectiologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France;6. Department of Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France;7. European Hospital Georges Pompidou, AP-HP, Nuclear Medicine, Université Paris Descartes, Paris, France;8. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France;9. Université Paris Descartes, Sorbonne Paris Cité, Paris, France;10. INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France;11. Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France;12. Department of Cardiac Surgery, La Timone Hospital, Marseille, France |
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| Abstract: | ObjectivesThe primary objective was to assess the value of the European Society of Cardiology (ESC) criteria, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in prosthetic valve infective endocarditis (PVE). Secondary objectives were: 1) to assess the reproducibility of 18F-FDG-PET/CT; 2) to compare its diagnostic value with that of echocardiography; and 3) to assess the diagnostic value of the presence of a diffuse splenic uptakeBackground18F-FDG PET/CT has been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines, but the benefit of the ESC criteria has not been prospectively compared with the conventional Duke criteria.MethodsBetween 2014 and 2017, 175 patients with suspected PVE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable 18F-FDG PET/CT, 115 patients were evaluated, including 91 definite and 24 rejected IE, as defined by an expert consensus.ResultsCardiac uptake by 18F-FDG PET/CT was observed in 67 of 91 patients with definite PVE and 6 with rejected IE (sensitivity 73.6% 95% confidence interval (CI): 63.3% to 82.3%], specificity 75% 95% CI: 53.3% to 90.2%]). The ESC 2015 classification increased the sensitivity of Duke criteria from 57.1% (95% CI: 46.3% to 67.5%) to 83.5% (95% CI: 74.3% to 90.5%) (p < 0.001), but decreased its specificity from 95.8% (95% CI: 78.9% to 99.9%) to 70.8% (95% CI: 48.9% to 87.4%). Intraobserver reproducibility of 18F-FDG PET/CT was good (kappa = 0.84) but interobserver reproducibility was less satisfactory (kappa = 0.63). A diffuse splenic uptake was observed in 24 (20.3%) patients, including 23 (25.3%) of definite PVE, and only 1 (4.2%) rejected PVE (p = 0.024).Conclusions18F-FDG PET/CT is a useful diagnostic tool in suspected PVE, and explains the greater sensitivity of ESC criteria than Duke criteria. However, 18F-FDG PET/CT also presents with important limitations concerning its feasibility, specificity, and reproducibility. Our study describes for the first time a new endocarditis criterion, that is, the presence of a diffuse splenic uptake on 18F-FDG PET/CT. |
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| Keywords: | endocarditis guidelines nuclear imaging valve disease CRP"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"C-reactive protein ESC"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"European Society of Cardiology IE"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"infective endocarditis PVE"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"prosthetic valve endocarditis TEE"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"transesophageal echocardiography |
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