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Impact of systematic whole-body 18F-fluorodeoxyglucose PET/CT on the management of patients suspected of infective endocarditis: the prospective multicenter TEPvENDO study

Xavier Duval 1, 2 Vincent Le Moing 3, 4 Sarah Tubiana 2 Marina Esposito-Farèse 1 Emila Ilic-Habensus 1 Florence Leclercq 4 Aurélie Bourdon 4 François Goehringer 5 Christine Selton-Suty 6 Elodie Chevalier 6 David Boutoille 7, 8 Nicolas Piriou 9 Thierry Le Tourneau 9 Catherine Chirouze 10 Marie-France Seronde 11 Olivier Morel 12 Lionel Piroth 12, 13 Jean-Christophe Eicher 14, 15 Olivier Humbert 15 Matthieu Revest 16, 17, 18 Elise Thébault 18, 16 Anne Devillers 19, 16 François Delahaye 20 André Boibieux 21 Bastien Grégoire 20 Bruno Hoen 5 Cédric Laouénan 1, 2 Bernard Iung 1, 2 François Rouzet 1, 2
Abstract : Diagnostic and patients' management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients. 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients' management plan were established jointly by two experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients' management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established. Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (p<0.001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (p=0.005) (net reclassification index 20% and 4.3%). Patients' managements were modified in 21.4% PV and 31.4% NV patients (p=0.25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% CI: 32-48), which was most likely to occur in those with a non-contributing echocardiography (p<0.001) or IE classified as possible at baseline (p=0.04), while there was no difference between NV and PV. Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients.
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Xavier Duval, Vincent Le Moing, Sarah Tubiana, Marina Esposito-Farèse, Emila Ilic-Habensus, et al.. Impact of systematic whole-body 18F-fluorodeoxyglucose PET/CT on the management of patients suspected of infective endocarditis: the prospective multicenter TEPvENDO study. Clinical Infectious Diseases, Oxford University Press (OUP), 2020, ⟨10.1093/cid/ciaa666⟩. ⟨hal-02893638⟩

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