Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections

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 topograp...

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Authors: Miró Meda, José M. (José María), 1956-, HernándezMeneses,Marta, 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
Format: article
Status:Versión aceptada para publicación
Publication Date:2023
Country:España
Institution:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repository:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/209329
Online Access:https://hdl.handle.net/2445/209329
Access Level:Open access
Keyword:Endocarditis
Marcapassos
Infeccions
Desfibril·ladors cardioversors implantables
Cardiac pacemakers
Infections
Implantable cardioverter-defibrillators
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spelling Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infectionsMiró Meda, José M. (José María), 1956-HernándezMeneses,MartaPerissinotti, AndrésPáez Martínez, SilviaLlopis Pérez, JaimeDahl, AndersSandoval, ElenaFalces Salvador, CarlesAmbrosioni, JuanVidal, BàrbaraMarco, FrancescCuervo Requena, GuillermoMoreno Poyato, Antonio RafaelBosch Mestres, JordiTolosana, José M. (José María)Fuster Pelfort, DavidHospital Clínic of Barcelona Infective Endocarditis Team InvestigatorsEndocarditisMarcapassosInfeccionsDesfibril·ladors cardioversors implantablesEndocarditisCardiac pacemakersInfectionsImplantable cardioverter-defibrillatorsIntroduction 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.Elsevier España2024202420232024info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersion10 p.application/pdfhttps://hdl.handle.net/2445/209329Articles publicats en revistes (Genètica, Microbiologia i Estadística)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésVersió postprint del document publicat a: https://doi.org/10.1016/j.rec.2023.04.001Revista Española de Cardiologia, 2023, vol. 76, num.12, p. 970-979https://doi.org/10.1016/j.rec.2023.04.001cc-by-nc-nd (c) Elsevier España, 2023http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/2093292026-05-29T05:05:01Z
dc.title.none.fl_str_mv Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
title Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
spellingShingle Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
Miró Meda, José M. (José María), 1956-
Endocarditis
Marcapassos
Infeccions
Desfibril·ladors cardioversors implantables
Endocarditis
Cardiac pacemakers
Infections
Implantable cardioverter-defibrillators
title_short Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
title_full Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
title_fullStr Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
title_full_unstemmed Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
title_sort Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections
dc.creator.none.fl_str_mv Miró Meda, José M. (José María), 1956-
HernándezMeneses,Marta
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
author Miró Meda, José M. (José María), 1956-
author_facet Miró Meda, José M. (José María), 1956-
HernándezMeneses,Marta
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
author_role author
author2 HernándezMeneses,Marta
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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Endocarditis
Marcapassos
Infeccions
Desfibril·ladors cardioversors implantables
Endocarditis
Cardiac pacemakers
Infections
Implantable cardioverter-defibrillators
topic Endocarditis
Marcapassos
Infeccions
Desfibril·ladors cardioversors implantables
Endocarditis
Cardiac pacemakers
Infections
Implantable cardioverter-defibrillators
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023
2024
2024
2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/209329
url https://hdl.handle.net/2445/209329
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Versió postprint del document publicat a: https://doi.org/10.1016/j.rec.2023.04.001
Revista Española de Cardiologia, 2023, vol. 76, num.12, p. 970-979
https://doi.org/10.1016/j.rec.2023.04.001
dc.rights.none.fl_str_mv cc-by-nc-nd (c) Elsevier España, 2023
http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by-nc-nd (c) Elsevier España, 2023
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 10 p.
application/pdf
dc.publisher.none.fl_str_mv Elsevier España
publisher.none.fl_str_mv Elsevier España
dc.source.none.fl_str_mv Articles publicats en revistes (Genètica, Microbiologia i Estadística)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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