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Title: Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
Author: Miró Meda, José M.
Perissinotti, Andrés
Páez Martínez, Silvia
Llopis Pérez, Jaime
Dahl, Anders
Sandoval, Elena
Falces Salvador, Carles
Ambrosioni, Juan
Vidal, Bàrbara
Marco, Francesc
Cuervo Requena, Guillermo
Moreno Poyato, Antonio Rafael
Bosch Mestres, Jordi
Tolosana, José M. (José María)
Fuster Pelfort, David
Hospital Clínic of Barcelona Infective Endocarditis Team Investigators
Keywords: Endocarditis
Desfibril·ladors cardioversors implantables
Cardiac pacemakers
Implantable cardioverter-defibrillators
Issue Date: 6-Apr-2023
Publisher: Elsevier España
Abstract: Introduction and objectives: The role of [18F]FDG-PET/CT in cardiac implantable electronic device (CIED) infections requires better evaluation, especially in the diagnosis of systemic infections. We aimed to determine the following: a) the diagnostic accuracy of [18F]FDG-PET/CT in each CIED topographical region, b) the added value of [18F]FDG-PET/CT over transesophageal echocardiography (TEE) in diagnosing systemic infections, c) spleen and bone marrow uptake in differentiating isolated local infections from systemic infections, and d) the potential application of [18F]FDG-PET/CT in follow-up. Methods: Retrospective single-center study including 54 cases and 54 controls from 2014 to 2021. The Primary endpoint was the diagnostic yield of [18F]FDG-PET/CT in each topographical CIED region. Secondary analyses described the performance of [18F]FDG-PET/CT compared with that of TEE in systemic infections, bone marrow and spleen uptake in systemic and isolated local infections, and the potential application of [18F]FDG-PET/CT in guiding cessation of chronic antibiotic suppression when completed device removal is not performed. Results: We analyzed 13 (24%) isolated local infections and 41 (76%) systemic infections. Overall, the specificity of [18F]FDG-PET/CT was 100% and sensitivity 85% (79% pocket, 57% subcutaneous lead, 22% endovascular lead, 10% intracardiac lead). When combined with TEE, [18F]FDG-PET/CT increased definite diagnosis o fsystemic infections from 34% to 56% (P=.04). Systemic infections with bacteremia showed higher spleen (P=.05) and bone marrow metabolism (P=.04) than local infections. Thirteen patients without complete device removal underwent a follow-up [18F]FDG-PET/CT, with no relapses after discontinuation of chronic antibiotic suppression in 6 cases with negative follow-up [18F]FDG-PET/CT. Conclusions: The sensitivity of [18F]FDG-PET/CT for evaluating CIED infections was high in local infections but much lower in systemic infections. However, accuracy increased when [18F]FDG-PET/CT was combined with TEE in endovascular lead bacteremic infection. Spleen and bone marrow hypermetabolism could differentiate bacteremic systemic infection from local infection. Although further prospective studies are needed, follow-up [18F]FDG-PET/CT could play a potential role in the management of chronic antibiotic suppression therapy when complete device removal is unachievable.
Note: Versió postprint del document publicat a:
It is part of: Revista Española de Cardiologia, 2023, vol. 76, num.12, p. 970-979
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ISSN: 0300-8932
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Genètica, Microbiologia i Estadística)
Articles publicats en revistes (ISGlobal)

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