Prognostic Value of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Infective Endocarditis
Authors: Gilbert Habib
Hubert Lepidi
Michel Drancourt
Hélène Martel
Olivier Torras
Alberto Riberi
Frederic Collart
Giulia Norscini
Florent Arregle
Sovannarith San
Laurence Camoin
Flora Lavagna
Mary Philip
Jean-François Avierinos
Sandrine Hubert
Sébastien Renard
Leopold Oliver
Eleonore Ravis
Anne Claire Casalta
Laetitia Tessonier
Didier Raoult
Frédérique Gouriet
Serge Cammilleri
Jean Paul Casalta
Pierre Ambrosi
Journal: Journal of the American College of Cardiology (2019)
Discipline: CLINICAL MEDICINE
Keywords: endocarditis; valve disease.
Affiliations: APHM, La Timone Hospital, Cardiology Department, Marseille, France., Department of Nuclear Medicine, La Timone Hospital, Marseille, France., Aix Marseille University, IRD (Institut de Recherche pour le Développement), APHM (Assistance Publique Hôpitaux de Marseille), MEPHI (Microbes, Evolution, Phylogénie et Infection), IHU (Institut Hospitalo-universitaire)-Méditerranée Infection, Marseille, France., Department of Cardiac Surgery, La Timone Hospital, Marseille, France., APHM, La Timone Hospital, Cardiology Department, Marseille, France; Aix Marseille University, IRD (Institut de Recherche pour le Développement), APHM (Assistance Publique Hôpitaux de Marseille), MEPHI (Microbes, Evolution, Phylogénie et Infection), IHU (Institut Hospitalo-universitaire)-Méditerranée Infection, Marseille, France. Electronic address: .

Abstract:  Background: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is commonly used for the diagnosis of infective endocarditis (IE), but its prognostic value remains unknown. Objectives: This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE). Methods: This study prospectively included 173 consecutive patients (109 PVE and 64 NVE) with definite left-sided IE who had an 18F-FDG PET/CT and were followed-up for 1 year. The primary endpoint was a composite of major cardiac events: death, recurrence of IE, acute cardiac failure, nonscheduled hospitalization for cardiovascular indication, and new embolic event. Results: 18F-FDG PET/CT was positive in 100 (58%) patients, 83% (n = 90 of 109) in the PVE, and 16% (n = 10 of 64) in the NVE group. At a mean follow-up of 225 days (interquartile range: 199 to 251 days), the primary endpoint occurred in 94 (54%) patients: 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with a higher rate of primary endpoint (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.1 to 6.7; p = 0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (HR: 2.3; 95% CI: 1.3 to 4.5; p = 0.03) and to new embolic events in PVE (HR: 7.5; 95% CI: 1.24 to 45.2; p = 0.03) and in NVE (HR: 8.8; 95% CI: 1.1 to 69.5; p = 0.02). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary endpoint CONCLUSIONS: In addition to its good diagnostic performance, 18F-FDG PET/CT is predictive of major cardiac events in PVE and new embolic events within the first year following IE. 

Retracted: No

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