Author + information
- Received February 10, 2020
- Revision received March 23, 2020
- Accepted April 10, 2020
- Published online June 17, 2020.
- Mary Philip, MDa,
- Laetitia Tessonier, MDb,
- Julien Mancini, MD, PhDc,d,
- Jean-Luc Mainardi, MDe,
- Marie-Paule Fernandez-Gerlinger, MDe,
- David Lussato, MDf,
- David Attias, MDf,
- Serge Cammilleri, MDb,
- Pierre Weinmann, MDg,
- Albert Hagege, MDh,i,j,
- Florent Arregle, MDa,
- Hélène Martel, MDa,
- Leopold Oliver, MDa,
- Laurence Camoin, MD, PhDk,
- Anne Claire Casalta, MDa,
- Jean Paul Casalta, MDk,
- Frédérique Gouriet, MD, PhDk,
- Alberto Riberi, MDl,
- Hubert Lepidi, MD, PhDk,
- Didier Raoultk,
- Michel Drancourt, MD, PhDk and
- Gilbert Habib, MD, PhDa,k,∗ ()
- aAPHM, La Timone Hospital, Cardiology Department, Marseille, France
- bDepartment of Nuclear Medicine, La Timone Hospital, Marseille, France
- cAix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
- dAPHM, Hôpital de la Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
- eAssistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service de Microbiologie, Unité Mobile d'infectiologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
- fDepartment of Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France
- gEuropean Hospital Georges Pompidou, AP-HP, Nuclear Medicine, Université Paris Descartes, Paris, France
- hAssistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France
- iUniversité Paris Descartes, Sorbonne Paris Cité, Paris, France
- jINSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France
- kAix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- lDepartment of Cardiac Surgery, La Timone Hospital, Marseille, France
- ↵∗Address for correspondence:
Dr. Gilbert Habib, Service de Cardiologie, Hôpital La Timone, Boulevard Jean Moulin 13005 Marseille, France.
Objectives The 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 uptake
Background 18F-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.
Methods Between 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.
Results Cardiac 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).
Conclusions 18F-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.
This study was supported by grants from the PHRC (projet hospitalier de recherche clinique) PHRC 2012 n° 2013-01 et -la Fondation Coeur et Recherche.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received February 10, 2020.
- Revision received March 23, 2020.
- Accepted April 10, 2020.
- 2020 American College of Cardiology Foundation
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