Hadji-Turdeghal Katra, Fosbøl Marie Øbro, Hasbak Philip, Kjaer Andreas, Køber Lars, Ripa Rasmus Sejersten, Fosbøl Emil Loldrup
Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, 2100 Copenhagen, Denmark.
Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, 2100 Copenhagen, Denmark.
Eur Heart J Case Rep. 2024 Aug 20;8(9):ytae431. doi: 10.1093/ehjcr/ytae431. eCollection 2024 Sep.
Infective endocarditis (IE) is a serious and fatal condition, with prosthetic valve endocarditis representing the worst prognosis. The recommended nuclear imaging modality 2-deoxy-2-[F]fluoro-D-glucose positron emission tomography/computed tomography ([F]FDG PET/CT) has limitations. In this case series, we present two patients with IE scanned with a novel PET tracer [Cu]Cu-DOTATATE ([Cu]Cu-[1,4,7,10-tetraazacyclododecane-,',″,‴-tetra acetic acid]-d-Phe1, Tyr3-octreotate).
An 84-year-old female patient (Patient 1) with a biological mitral valve prosthesis (MVP) was admitted acutely from the outpatient clinic. Transoesophageal echocardiography showed vegetations on the MVP. The patient underwent [Cu]Cu-DOTATATE PET/CT, which showed uptake at the site of infection. The patient underwent surgical valve replacement. The post-operative period was without significant complications, and the patient was discharged home. In another case, a 72-year-old male patient (Patient 2) with a medical history of mild mitral valve stenosis, aortic valve stenosis, and gastrointestinal stromal tumour was admitted to the hospital for back and abdominal pain and subfebrile episodes. Transoesophageal echocardiography showed large vegetations in the native aortic valve. The patient underwent [Cu]Cu-DOTATATE PET/CT, which showed no uptake at the site of the suspected infection. The patient underwent surgical valve replacement. The post-operative period was characterized by sternitis, and after prolonged hospitalization, the patient died of respiratory failure as a complication of sepsis.
In conclusion, this is the first case series presenting two patients with definite IE (modified Duke criteria), who were scanned with the novel [Cu]Cu-DOTATATE PET/CT. Patient 1, with endocarditis in the MVP, showed an uptake of the tracer, while Patient 2, with native aortic valve endocarditis, did not show any uptake.
感染性心内膜炎（IE）是一种严重的致命疾病，人工瓣膜心内膜炎的预后最差。推荐的核成像方式2-脱氧-2-[F]氟-D-葡萄糖正电子发射断层扫描/计算机断层扫描（[F]FDG PET/CT）存在局限性。在本病例系列中，我们介绍了两名感染性心内膜炎患者，他们接受了新型PET示踪剂[Cu]Cu-多柔比星（[Cu]Cu-[1,4,7,10-四氮杂环十二烷-N,N',N″,N‴-四乙酸]-d-苯丙氨酸1，酪氨酸3-奥曲肽）扫描。
一名84岁女性患者（患者1），植入生物二尖瓣假体（MVP），从门诊急性入院。经食管超声心动图显示MVP上有赘生物。患者接受了[Cu]Cu-多柔比星PET/CT检查，结果显示感染部位有摄取。患者接受了手术瓣膜置换。术后无明显并发症，患者出院回家。在另一病例中，一名72岁男性患者（患者2），有轻度二尖瓣狭窄、主动脉瓣狭窄和胃肠道间质瘤病史，因背部和腹部疼痛以及低热发作入院。经食管超声心动图显示天然主动脉瓣上有大的赘生物。患者接受了[Cu]Cu-多柔比星PET/CT检查，结果显示疑似感染部位无摄取。患者接受了手术瓣膜置换。术后出现胸骨炎，经过长时间住院，患者因败血症并发症呼吸衰竭死亡。
总之，这是首个病例系列，介绍了两名符合明确感染性心内膜炎（改良杜克标准）的患者，他们接受了新型[Cu]Cu-多柔比星PET/CT扫描。患者1，MVP心内膜炎，示踪剂有摄取，而患者2，天然主动脉瓣心内膜炎，未显示任何摄取。
