APHM, La Timone Hospital, Cardiology Department, Marseille, France.
Department of Nuclear Medicine, La Timone Hospital, Marseille, France.
J Am Coll Cardiol. 2019 Aug 27;74(8):1031-1040. doi: 10.1016/j.jacc.2019.06.050.
F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) is commonly used for the diagnosis of infective endocarditis (IE), but its prognostic value remains unknown.
This study sought to assess the prognostic value of F-FDG PET/CT in prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE).
This study prospectively included 173 consecutive patients (109 PVE and 64 NVE) with definite left-sided IE who had an F-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.
F-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 F-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 F-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, F-FDG PET/CT was not associated with occurrence of the primary endpoint CONCLUSIONS: In addition to its good diagnostic performance, F-FDG PET/CT is predictive of major cardiac events in PVE and new embolic events within the first year following IE.
氟-18 脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）常用于感染性心内膜炎（IE）的诊断，但它的预后价值仍不清楚。
本研究旨在评估 F-FDG PET/CT 在人工瓣膜心内膜炎（PVE）和原生瓣膜心内膜炎（NVE）中的预后价值。
本研究前瞻性纳入了 173 例经 F-FDG PET/CT 确诊的左心 IE 连续患者（109 例 PVE 和 64 例 NVE），并进行了 1 年的随访。主要终点是主要心脏不良事件的复合终点：死亡、IE 复发、急性心力衰竭、心血管原因非计划性住院和新发栓塞事件。
F-FDG PET/CT 阳性患者 100 例（58%），其中 PVE 患者 83%（90/109），NVE 患者 16%（10/64）。平均随访 225 天（四分位距：199 至 251 天），主要终点发生在 94 例患者中（54%）：PVE 组 63 例（58%），NVE 组 31 例（48%）。在 PVE 组中，阳性 F-FDG PET/CT 与更高的主要终点发生率显著相关（风险比 [HR]：2.7；95%置信区间 [CI]：1.1 至 6.7；p=0.04）。中度至强烈的 F-FDG 瓣膜摄取也与较差的预后相关（HR：2.3；95%CI：1.3 至 4.5；p=0.03），并与 PVE 中的新发栓塞事件相关（HR：7.5；95%CI：1.24 至 45.2；p=0.03）和 NVE 中的新发栓塞事件相关（HR：8.8；95%CI：1.1 至 69.5；p=0.02）。在 NVE 组中，F-FDG PET/CT 与主要终点的发生无关。
除了良好的诊断性能外，F-FDG PET/CT 还可以预测 PVE 中的主要心脏事件和 IE 后第一年的新发栓塞事件。
