Author + information
- Received March 7, 2017
- Revision received May 13, 2017
- Accepted May 18, 2017
- Published online August 16, 2017.
- Erwan Salaun, MDa,b,c,∗ (, )
- Laura Sportouch, MDa,
- Pierre-Antoine Barral, MDb,d,
- Sandrine Hubert, MDa,
- Cécile Lavoute, PhDa,
- Anne-Claire Casalta, MDa,
- Julie Pradier, MDa,
- Daniel Ouk, MDe,
- Jean-Paul Casalta, MDc,
- Marc Lambert, MDa,
- Frédérique Gouriet, MD, PhDc,
- Jean-Yves Gaubert, MDd,
- Aurélie Dehaene, MDd,
- Alexis Jacquier, MD, PhDb,d,
- Laetitia Tessonnier, MDe,
- Julie Haentjens, PhDa,
- Alexis Theron, MDf,
- Alberto Riberi, MDf,
- Serge Cammilleri, MD, PhDe,
- Dominique Grisoli, MDf,
- Nicolas Jaussaud, MDf,
- Frédéric Collart, MDf,
- Jean-Louis Bonnet, MDa,
- Laurence Camoin, PharD, PhDc,
- Sebastien Renard, MDa,
- Thomas Cuisset, MD, PhDa,
- Jean-François Avierinos, MD, PhDa,
- Hubert Lepidi, MDc,
- Olivier Mundler, MD, PhDe,
- Didier Raoult, MD, PhDc and
- Gilbert Habib, MDa,c
- aCardiology Department, Assistance Publique Hôpitaux de Marseille (APHM)-La Timone Hospital, Marseille, France
- bCentre de Résonance Magnétique Biologique et Médicale UMR 7339, Centre National de la Recherche Scientifique, Aix-Marseille Université, Marseille, France
- cUnité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Aix-Marseille Université—UM63, Centre National de la Recherche Scientifique 7278, IRD 198, Institut National de la Santé et de la Recherche Médicale 1095-IHU—Méditerranée Infection, Marseille, France
- dDepartment of Radiology and Cardiovascular Imaging, APHM-La Timone Hospital, Marseille, France
- eService Central de Biophysique et Médecine Nucléaire, APHM-La Timone Hospital, Marseille, France
- fCardiac Surgery Department, APHM-La Timone Hospital, Marseille, France
- ↵∗Address for correspondence:
Dr. Erwan Salaun, La Timone Hospital, Cardiology Department, Boulevard Jean Moulin, 13005-Marseille, France.
Diagnosis of infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) remains difficult to establish using modified Duke criteria. We present the value of multi-imaging approach (European Society of Cardiology [ESC]-2015 modified criteria) (1) in 16 patients referred for TAVR-IE suspicion (Figures 1 to 4⇓⇓⇓⇓, Online Tables 1 and 2). The final diagnosis defined by an expert-team at 3 months of follow-up was definite-IE in 10, possible-IE in 1, and rejected-IE in 5. Echocardiography (n = 16) revealed major criteria in 5 patients (5 vegetations, 2 paravalvular lesions) (Online Table 3) and new regurgitation in only 1 of them (Online Figure 1). Leaflet thickening and increased mean gradient were observed respectively in 70% and 80% of definite-IE. Multislice computed tomography (CT) (n = 11) identified major criteria in 2 patients (1 abscess, 1 pseudoaneurysm, and 1 fistulae), but evidenced vegetation and leaflet thickening in 3 and 5 patients, respectively (Online Table 3). 18F-fluorodeoxyglucose positron-emission tomography/CT (n = 15) was positive in 9, and 18F-fluorodeoxyglucose uptake on transcatheter heart valve was observed in all patients with definite-IE, except 1 (Online Table 6).
Comparing the classification on admission and the final diagnosis, the multi-imaging approach (ESC-2015 modified criteria) presented with a higher diagnostic value (sensitivity = 100% for definite-IE diagnosis, κ = 0.66 for all classes) than the modified Duke criteria (sensitivity = 50%, κ = 0.21) (Online Figure 1, Online Tables 4 and 5).
To conclude, in TAVR-IE: 1) atypical lesions of leaflets thickening and high transvalvular gradient (obstructive pattern) are frequent. 2) Conventional modified Duke criteria have a low diagnostic value; while multi-imaging approach (ESC-2015 modified criteria) have an excellent sensitivity in this setting, thanks to the use of multimodality imaging (Online Figure 2).
For supplemental methods, results, tables, and figures, please see the online version of this paper.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 7, 2017.
- Revision received May 13, 2017.
- Accepted May 18, 2017.
- 2017 American College of Cardiology Foundation
- Habib G.,
- Lancellotti P.,
- Antunes M.J.,
- et al.