Department of Nuclear Medicine, AP-HP, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
INSERM U970, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
J Nucl Cardiol. 2023 Dec;30(6):2633-2643. doi: 10.1007/s12350-023-03335-y. Epub 2023 Jul 10.
Our objective was to evaluate in patients with prosthetic valve endocarditis (PVE) treated conservatively, the prognostic value of white blood cell (WBC) signal intensity on SPECT and to describe the evolution of the WBC signal under antibiotics.
Patients with PVE treated conservatively and positive WBC-SPECT imaging were identified retrospectively. Signal intensity was classified as intense if equal to or higher, or mild if lower, than the liver signal. Clinical, biological, imaging and follow-up information were collected from medical files.
Among 47 patients, WBC signal was classified as intense in 10 patients and as mild, in 37. The incidence of the primary composite endpoint (death, late cardiac surgery, or relapse) was significantly higher in patients with intense vs. mild signal (90% vs. 11%). Twenty-five patients underwent a second WBC-SPECT imaging during follow-up. The prevalence of WBC signal decreased progressively from 89% between 3 and 6 weeks to 42% between 6 and 9 weeks and 8% more than 9 weeks after initiation of antibiotics.
In patients with PVE treated conservatively, intense WBC signal was associated with poor outcome. WBC-SPECT imaging appears as an interesting tool for risk stratification and to monitor locally the efficacy of antibiotic treatment.
我们的目的是评估保守治疗的人工瓣膜心内膜炎（PVE）患者中，白细胞（WBC）单光子发射计算机断层扫描（SPECT）信号强度的预后价值，并描述抗生素治疗下 WBC 信号的变化。
回顾性确定保守治疗且 WBC-SPECT 成像阳性的 PVE 患者。信号强度被分类为高强度，如果与肝脏信号相等或更高，或轻度，如果低于肝脏信号。从病历中收集了临床、生物学、影像学和随访信息。
在 47 名患者中，10 名患者的 WBC 信号被分类为高强度，37 名患者为轻度。高强度信号组与轻度信号组相比，主要复合终点（死亡、晚期心脏手术或复发）的发生率显著更高（90% vs. 11%）。25 名患者在随访期间进行了第二次 WBC-SPECT 成像。抗生素治疗开始后 3 至 6 周时，WBC 信号的发生率从 89%逐渐下降至 6 至 9 周时的 42%，9 周后则降至 8%。
在保守治疗的 PVE 患者中，高强度的 WBC 信号与不良预后相关。WBC-SPECT 成像似乎是一种用于风险分层和监测抗生素治疗局部疗效的有趣工具。
