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Comment
. 2021 Aug 2;73(3):393-403.
doi: 10.1093/cid/ciaa666.

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   3   4 , Vincent Le Moing  5 , Sarah Tubiana  1   2   3 , Marina Esposito-Farèse  1   2   6 , Emila Ilic-Habensus  1   2 , Florence Leclercq  7 , Aurélie Bourdon  8 , François Goehringer  9 , Christine Selton-Suty  10 , Elodie Chevalier  11 , David Boutoille  12 , Nicolas Piriou  13   14 , Thierry Le Tourneau  13 , Catherine Chirouze  15 , Marie-France Seronde  16 , Olivier Morel  17 , Lionel Piroth  18 , Jean-Christophe Eicher  19 , Olivier Humbert  20 , Matthieu Revest  21   22 , Elise Thébault  22 , Anne Devillers  23 , François Delahaye  24 , André Boibieux  25 , Bastien Grégoire  26 , Bruno Hoen  9 , Cédric Laouenan  1   2   3   4   6 , Bernard Iung  1   2   3   4 , François Rouzet  1   2   3   4   27 ; AEPEI-TEPvENDO study group
Collaborators, Affiliations
Free article
Comment

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 et al. Clin Infect Dis. .
Free article

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.

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