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; Vincent Le Moing; Sarah Tubiana; Marina Esposito-Farèse; Emila Ilic-Habensus; Florence Leclercq; Aurélie Bourdon; François Goehringer; Christine Selton-Suty; Elodie Chevalier; David Boutoille; Nicolas Piriou; Thierry Le Tourneau; Catherine Chirouze; Marie-France Seronde; Olivier Morel; Lionel Piroth; Jean-Christophe Eicher; Olivier Humbert; Matthieu Revest; Elise Thébault; Anne Devillers; François Delahaye; André Boibieux; Bastien Grégoire; Bruno Hoen; Cédric Laouénan; Bernard Iung; François Rouzet

doi:10.1093/cid/ciaa666

Journal articles

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, 11} Marie-France Seronde ¹² Olivier Morel ¹¹ Lionel Piroth ^{11, 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}

1 CIC - CHU Bichat

2 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution

3 UM - Université de Montpellier

4 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]

5 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy

6 Service de Cardiologie [CHRU Nancy]

7 CHU Nantes - Centre hospitalier universitaire de Nantes

8 CIC Nantes - Centre d’Investigation Clinique de Nantes

9 ITX - unité de recherche de l'institut du thorax UMR1087 UMR6291

10 LCE - Laboratoire Chrono-environnement - CNRS - UFC (UMR 6249)

11 CHRU Besançon - Centre Hospitalier Régional Universitaire [Besançon]

12 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920)

13 CIC-P803 - Centre d'Investigation Clinique 1432 (Dijon) - Module Plurithématique : Périnatalité Cancérologie Handicap et Ophtalmologie

14 Centre de génétique - Centre de référence des maladies rares, anomalies du développement et syndromes malformatifs (CHU de Dijon)

15 CHU Dijon

16 CHU Pontchaillou [Rennes]

17 BRM - ARN régulateurs bactériens et médecine

18 CIC - Centre d'Investigation Clinique [Rennes]

19 CRLCC - Centre Eugène Marquis

20 HCL - Hospices Civils de Lyon

21 Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL]

Abstract : Background - 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. Methods - 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. Results - 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. Conclusions - Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients.

Keywords : infective endocarditis diagnostic impact patient management 18F-FDG-PET/CT

Document type :

Journal articles

Domain :

Life Sciences [q-bio] / Human health and pathology / Infectious diseases

Life Sciences [q-bio] / Human health and pathology / Cardiology and cardiovascular system

Life Sciences [q-bio] / Bioengineering / Imaging

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