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-lab - Unité de recherche de l'institut du thorax
10 LCE - Laboratoire Chrono-environnement (UMR 6249)
11 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
12 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 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]

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 - In sum, 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 2 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 < .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 = .005) (net reclassification index 20% and 4.3%). Patients' managements were modified in 21.4% PV and 31.4% NV patients (P = .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% confidence interval: 32-48), which was most likely to occur in those with a noncontributing echocardiography (P < .001) or IE classified as possible at baseline (P = .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. Clinical trials registration - NCT02287792.

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

Domains: 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

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, 2021, 73 (3), pp.393-403. ⟨10.1093/cid/ciaa666⟩. ⟨hal-02893638⟩