Comparison of diagnostic performance of transesophageal echocardiography and positron emission tomography in patients with cardiovascular implantable electronic device infections.

BACKGROUND

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.

AIMS

The study aimed to compare diagnostic performance of 18F-FDG PET/CT and TEE in detecting lead endocarditis (LE).

METHODS

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.

RESULTS

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).

CONCLUSION

18F-FDG PET/CT is superior to TEE in diagnosing IE in patients with CIED.