Impact of Systematic Whole-body 18F-Fluorodeoxyglucose PET/CT on the Management of Patients Suspected of Infective Endocarditis: The Prospective Multicenter TEPvENDO Study
Authors: Duval Xavier , Le Moing Vincent , Tubiana Sarah , Esposito-Farèse Marina , Ilic-Habensus Emila , Leclercq Florence , Bourdon Aurélie , Goehringer François , Selton-Suty Christine , Chevalier Elodie , Boutoille David , Piriou Nicolas , Le Tourneau Thierry , Chirouze Catherine , Seronde Marie-France , Morel Olivier , Piroth Lionel , Eicher Jean-Christophe , Humbert Olivier , Revest Matthieu , Thébault Elise , Devillers Anne , Delahaye François , Boibieux André , Grégoire Bastien , Hoen Bruno , Laouenan Cédric , Iung Bernard , Rouzet François ,   AEPEI-TEPvENDO study group, Duval Xavier , Hoen Bruno , Iung Bernard , Rouzet Francois , Tubiana Sarah , Albayrak Tubanur , Bernard Yvette , Boulahdour Hatem , Briand Florent , Chirouze Catherine , Faucher Jean-François , Guignier Alexandre , Hustache-Mathieu Laurent , Illes-Hajnal Gabriela , Moreau Joséphine , Morel Olivier , Seronde Marie-France , Behechti Niloufar , Blot Mathieu , Buisson Marielle , Cochet Alexandre , Eicher Jean-Christophe , Humbert Olivier , Lecluse-Barth Julien , Mahy Sophie , Piroth Lionel , Andre Philippe , Delahaye François , Delahaye Armelle , Grégoire Bastien , Bourdon Aurélie , Cade Stéphane , Casanova Marie-Laure , Cerutti Diane , De Verbizier Delphine , Le Moing Vincent , Martinez Angelina , Morquin David , Solecki Kamila , Bonay Stéphanie , Chevalier Elodie , Claudin Marine , Djaballah Wassila , Goehringer François , Huttin Olivier , Jeanmaire Eliette , Marie Pierre-Yves , Roch Véronique , Selton-Suty Christine , Vauthier Sandrine , Venner Clément , Asseray Nathalie , Biron Charlotte , Boutoille David , Brochard-Libois Julia , Cavellec Morgane , Cueff Caroline , Delarue Sandrine , Di Prizio Catherine , Dinc Levent , Fellah Imen , Guijarro Damien , Lachaud Mathias , Le Gloan Laurianne , Le Tourneau Thierry , Lecompte Anne-Sophie , Lefebvre Maeva , Luçon Adrien , Mathieu Cédric , Orain Jérémie , Pallardy Amandine , Piriou Nicolas , Poilane Maxime , Sassier Jérôme , Ben Ali Khadija , Brochet Eric , Burdet Charles , Celestin Bettia , Cimadevilla Claire , Duval Xavier , Hiafyl Fabien , Ilic-Habensus Emila , Iung Bernard , Lachatre Marie , Lepage Laurent , Lescure Xavier , Rouzet François , Vindrios William , Wolff Michel , Yazdanpanah Yazdan , Devillers Anne , Donal Erwan , Lacroix Adèle , Lelong Bernard , Revest Matthieu , Tattevin Pierre , Thebault Elise , Couffignal Camille , Esposito-Farese Marina , Laouenan Cédric , Maklouf Sonia , Mentre France , Prevault Margot , Rogier Ophélie 
Published: May 2020

Background

Diagnostic and patients’ management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients.

Methods

In sum, 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients’ management plan were established jointly by 2 experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients’ management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established.

Results

Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (P &lt; .001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (P = .005) (net reclassification index 20% and 4.3%). Patients’ managements were modified in 21.4% PV and 31.4% NV patients (P = .25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% confidence interval: 32–48), which was most likely to occur in those with a noncontributing echocardiography (P &lt; .001) or IE classified as possible at baseline (P = .04), while there was no difference between NV and PV.

Conclusions

Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients.

Clinical Trials Registration

NCT02287792.