Author + information
- Received October 17, 2019
- Revision received January 8, 2020
- Accepted January 16, 2020
- Published online June 17, 2020.
- Katarzyna Holcman, MDa,∗ (, )
- Paweł Rubiś, MD, PhDa,
- Andrzej Ząbek, MD, PhD, MScb,
- Bogdan Ćmiel, MSc, PhDc,
- Wojciech Szot, MD, PhDd,e,
- Krzysztof Boczar, MD, PhDb,
- Sylwia Wiśniowska-Śmiałek, MDa,
- Agnieszka Stępień, MDa,
- Barbara Małecka, MD, PhDb,
- Piotr Podolec, MD, PhDa and
- Magdalena Kostkiewicz, MD, PhDa,d
- aDepartment of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- bDepartment of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- cAGH University of Science and Technology, Faculty of Applied Mathematics, Krakow, Poland
- dDepartment of Nuclear Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- eDepartment of Hygiene and Dietetics, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- ↵∗Address for correspondence:
Dr. Katarzyna Holcman, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland.
Objectives This was a prospective, single-center study designed to assess the prognostic value of the hybrid technique of single photon emission tomography and computed tomography with the application of technetium99m-hexamethylpropyleneamine oxime–labelled autologous leukocytes (99mTc-HMPAO-SPECT/CT) in patients with cardiac device-related infective endocarditis (CDRIE).
Background CDRIE entails the risk of complications and an increase in mortality rates, both in-hospital and long-term. The prognostic value of 99mTc-HMPAO-SPECT/CT in the course of CDRIE has not been evaluated so far.
Methods The project enrolled 103 consecutive patients with suspected CDRIE, all of whom underwent 99mTc-HMPAO-SPECT/CT. The resulting scans were then classified as positive if the presence of abnormal tracer uptake involving cardiac and intravascular sections of the device electrodes was found. Patients were prospectively observed for a mean time of 17.48 ± 11.9 months. All-cause mortality, in-hospital mortality, and complete hardware removal were assessed, followed by a composite endpoint including complications, namely embolic events, new onset heart failure, uncontrolled infection, renal replacement therapy, reoperation, new heart rhythm, and conduction disturbances.
Results In the analysis, despite a noticeable trend, all-cause mortality rates were not found to be statistically significantly higher among the 35 patients who registered positive results using 99mTc-HMPAO-SPECT/CT for CDRIE (group 1) than among the 68 patients from group 2 whose 99mTc-HMPAO-SPECT/CT results were negative (20% vs. 10.3%, respectively; p = 0.14). However, group 1 did present higher in-hospital mortality (11.4% vs. 0%, respectively; odds ratio: 19.6; 95% confidence interval [CI]: 1.02 to 374.70), an increased rate of complications (43% vs. 9%, respectively; hazard ratio [HR]: 5.9; 95% CI: 2.27 to 15.20), and underwent hardware removal more frequently (57% vs. 16%, respectively; HR: 4.3; 95% CI: 2.07 to 19.08).
Conclusions In patients with suspected CDRIE, positive 99mTc-HMPAO-SPECT/CT results were associated with increased rates of in-hospital mortality and complications.
- cardiac device-related infective endocarditis
- radiolabeled leukocyte scintigraphy
Supported by Jagiellonian University Medical College grant K/DSC/004383. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 17, 2019.
- Revision received January 8, 2020.
- Accepted January 16, 2020.
- 2020 American College of Cardiology Foundation
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