Serifler Nazli Turan, Tan Kurklu Turkan Seda, Akbulut Koyuncu Irem Muge, Demirtola Ayse Irem, Turhan Sibel
Department of Cardiology, Ankara Etlik City Hospital, Ankara, Turkey.
Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey.
Kardiol Pol. 2024;82(10):958-966. doi: 10.33963/v.phj.101702. Epub 2024 Jul 30.
The modified Duke criteria and transesophageal echocardiography (TEE) are often insufficient to diagnose infective endocarditis in patients with cardiovascular implantable electronic devices (CIEDs). F-18-fluoro-2-deoxy-glucose positron emission tomography (18F-FDG PET/CT) is a promising method for detecting lead endocarditis.
The study aimed to compare diagnostic performance of 18F-FDG PET/CT and TEE in detecting lead endocarditis (LE).
We included 40 patients admitted to the hospital for CIED infection. Patients were classified as "LE-positive" and "LE-negative" according to TEE and 18F-FDG PET/CT findings. After three months of follow-up, the patients' lead cultures, tissue and blood cultures, and clinical responses after antibiotic treatment were reviewed using the Duke criteria. The final exact diagnosis was compared with 18F-FDG PET/CT and TEE findings.
No involvement was observed on 18F-FDG PET/CT in 12 patients (30%). The remaining 25% of patients had device pocket involvement, and two patients had systemic involvement. In the follow-up of 23 patients diagnosed with LE by TEE, 14 were consistent with LE. Seventeen of 18 patients with suspicion of LE were diagnosed with definite LE by 18F-FDG PET/CT. Six of the 22 patients with negative 18F-FDG PET/CT scans were false negative and diagnosed as definite infective endocarditis. 18F-FDG PET/CT had sensitivity of 73.9% and specificity of 94.1%. It was observed that there was a statistically significant difference between TEE and PET (P = 0.006).
18F-FDG PET/CT is superior to TEE in diagnosing IE in patients with CIED.
改良的杜克标准和经食管超声心动图（TEE）通常不足以诊断心血管植入式电子设备（CIED）患者的感染性心内膜炎。F-18-氟-2-脱氧葡萄糖正电子发射断层扫描（18F-FDG PET/CT）是检测导线心内膜炎的一种有前景的方法。
本研究旨在比较18F-FDG PET/CT和TEE在检测导线心内膜炎（LE）方面的诊断性能。
我们纳入了40例因CIED感染入院的患者。根据TEE和18F-FDG PET/CT检查结果，将患者分为“LE阳性”和“LE阴性”。在随访三个月后，使用杜克标准对患者的导线培养、组织和血培养以及抗生素治疗后的临床反应进行回顾。将最终的确切诊断与18F-FDG PET/CT和TEE检查结果进行比较。
12例患者（30%）的18F-FDG PET/CT未发现受累。其余25%的患者有设备袋受累，2例患者有全身受累。在TEE诊断为LE的23例患者的随访中，14例与LE一致。18例疑似LE的患者中有17例经18F-FDG PET/CT诊断为确诊LE。18F-FDG PET/CT扫描阴性的22例患者中有6例假阴性，被诊断为确诊感染性心内膜炎。18F-FDG PET/CT的敏感性为73.9%，特异性为94.1%。观察到TEE和PET之间存在统计学显著差异（P = 0.006）。
在诊断CIED患者的感染性心内膜炎方面，18F-FDG PET/CT优于TEE。
