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 Laouenan, Bernard Iung, François Rouzet, AEPEI-TEPvENDO study group, Xavier Duval, Bruno Hoen, Bernard Iung, Francois Rouzet, Sarah Tubiana, Tubanur Albayrak, Yvette Bernard, Hatem Boulahdour, Florent Briand, Catherine Chirouze, Jean-François Faucher, Alexandre Guignier, Laurent Hustache-Mathieu, Gabriela Illes-Hajnal, Joséphine Moreau, Olivier Morel, Marie-France Seronde, Niloufar Behechti, Mathieu Blot, Marielle Buisson, Alexandre Cochet, Jean-Christophe Eicher, Olivier Humbert, Julien Lecluse-Barth, Sophie Mahy, Lionel Piroth, Philippe Andre, François Delahaye, Armelle Delahaye, Bastien Grégoire, Aurélie Bourdon, Stéphane Cade, Marie-Laure Casanova, Diane Cerutti, Delphine De Verbizier, Vincent Le Moing, Angelina Martinez, David Morquin, Kamila Solecki, Stéphanie Bonay, Elodie Chevalier, Marine Claudin, Wassila Djaballah, François Goehringer, Olivier Huttin, Eliette Jeanmaire, Pierre-Yves Marie, Véronique Roch, Christine Selton-Suty, Sandrine Vauthier, Clément Venner, Nathalie Asseray, Charlotte Biron, David Boutoille, Julia Brochard-Libois, Morgane Cavellec, Caroline Cueff, Sandrine Delarue, Catherine Di Prizio, Levent Dinc, Imen Fellah, Damien Guijarro, Mathias Lachaud, Laurianne Le Gloan, Thierry Le Tourneau, Anne-Sophie Lecompte, Maeva Lefebvre, Adrien Luçon, Cédric Mathieu, Jérémie Orain, Amandine Pallardy, Nicolas Piriou, Maxime Poilane, Jérôme Sassier, Khadija Ben Ali, Eric Brochet, Charles Burdet, Bettia Celestin, Claire Cimadevilla, Xavier Duval, Fabien Hiafyl, Emila Ilic-Habensus, Bernard Iung, Marie Lachatre, Laurent Lepage, Xavier Lescure, François Rouzet, William Vindrios, Michel Wolff, Yazdan Yazdanpanah, Anne Devillers, Erwan Donal, Adèle Lacroix, Bernard Lelong, Matthieu Revest, Pierre Tattevin, Elise Thebault, Camille Couffignal, Marina Esposito-Farese, Cédric Laouenan, Sonia Maklouf, France Mentre, Margot Prevault, Ophélie Rogier, 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 Laouenan, Bernard Iung, François Rouzet, AEPEI-TEPvENDO study group, Xavier Duval, Bruno Hoen, Bernard Iung, Francois Rouzet, Sarah Tubiana, Tubanur Albayrak, Yvette Bernard, Hatem Boulahdour, Florent Briand, Catherine Chirouze, Jean-François Faucher, Alexandre Guignier, Laurent Hustache-Mathieu, Gabriela Illes-Hajnal, Joséphine Moreau, Olivier Morel, Marie-France Seronde, Niloufar Behechti, Mathieu Blot, Marielle Buisson, Alexandre Cochet, Jean-Christophe Eicher, Olivier Humbert, Julien Lecluse-Barth, Sophie Mahy, Lionel Piroth, Philippe Andre, François Delahaye, Armelle Delahaye, Bastien Grégoire, Aurélie Bourdon, Stéphane Cade, Marie-Laure Casanova, Diane Cerutti, Delphine De Verbizier, Vincent Le Moing, Angelina Martinez, David Morquin, Kamila Solecki, Stéphanie Bonay, Elodie Chevalier, Marine Claudin, Wassila Djaballah, François Goehringer, Olivier Huttin, Eliette Jeanmaire, Pierre-Yves Marie, Véronique Roch, Christine Selton-Suty, Sandrine Vauthier, Clément Venner, Nathalie Asseray, Charlotte Biron, David Boutoille, Julia Brochard-Libois, Morgane Cavellec, Caroline Cueff, Sandrine Delarue, Catherine Di Prizio, Levent Dinc, Imen Fellah, Damien Guijarro, Mathias Lachaud, Laurianne Le Gloan, Thierry Le Tourneau, Anne-Sophie Lecompte, Maeva Lefebvre, Adrien Luçon, Cédric Mathieu, Jérémie Orain, Amandine Pallardy, Nicolas Piriou, Maxime Poilane, Jérôme Sassier, Khadija Ben Ali, Eric Brochet, Charles Burdet, Bettia Celestin, Claire Cimadevilla, Xavier Duval, Fabien Hiafyl, Emila Ilic-Habensus, Bernard Iung, Marie Lachatre, Laurent Lepage, Xavier Lescure, François Rouzet, William Vindrios, Michel Wolff, Yazdan Yazdanpanah, Anne Devillers, Erwan Donal, Adèle Lacroix, Bernard Lelong, Matthieu Revest, Pierre Tattevin, Elise Thebault, Camille Couffignal, Marina Esposito-Farese, Cédric Laouenan, Sonia Maklouf, France Mentre, Margot Prevault, Ophélie Rogier
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: 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; diagnostic impact; infective endocarditis; patient management.
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Source: PubMed