Skip to main content

Advertisement

SpringerLink
Log in

Computed tomography with positron emission tomography is more useful in local than systemic infectious process related to cardiac implanted electrotherapy device: a prospective controlled multicenter diagnostic intervention PET-Guidance Trial

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Assess the diagnostic value of 18-F FDG PET/CT in cardiac implantable electronic devices (CIED) infections in facilitating diagnostic process and optimizing decision-making process.Study group (n = 21) patients with initial suspected diagnosis of CIED-related infection or fever of unknown origin and patients referred for device removal due to infection. Control group (n = 13) patients with implanted CIED, who underwent PET/CT due to other non-infectious indications and had no data for infectious process in follow-up.PET/CT scan showed pocket infection in 12 patients (including 1 in whom infection was not finally diagnosed—the examination was performed early after the implantation procedure—1.5 months), increased tracer uptake in intravascular lead part in 3 patients, and increased uptake in intracardiac part in 5 patients.We found that sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis made by PET/CT in generator pocket infection was 91.7%, 70%, 78.6%, 87.5% and in lead-dependent intracardiac infection 100%, 47.1%, 35.7%, 100% respectively. PET/CT scan enabled reclassification of diagnosis from possible to definite CIED-related infection in 6 out of 9 patients, and to excluded in 3 out of 9.Establishing diagnosis of device related infections may be challenging due to non-specific symptoms. Incorporation of PET/CT scan in the diagnostic schema can improve accuracy and timing of the diagnosis and help to assess the extent of infection. PET/CT is more useful in local than systemic infectious process related to cardiac implanted electrotherapy device.

Trial registration Consent of the bioethics committee nr IK-NP.-0021–85/1465/14. Registration in the www.clinicaltrials.gov database: NCT02196753.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Baddour LM, Epstein AE, Erickson CC et al (2010) American heart association rheumatic fever, endocarditis, and kawasaki disease committee; council on cardiovascular disease in young; council on cardiovascular surgery and anesthesia; council on cardiovascular nursing; council on clinical cardiology; interdisciplinary council on quality of care; american heart association. update on cardiovascular implantable electronic device infections and their management: a scientific statement from the american heart association. Circulation 121(3):458–477

    Article  PubMed  Google Scholar 

  2. Klug D, Balde M, Pavin D et al (2007) Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation 116:1349–1355

    Article  PubMed  Google Scholar 

  3. Bongiorni MG, Marinskis G, Lip GY et al (2012) How european centers diagnose, treat, and prevent CIED infections: results of an european heart rhythm association survey. Europace 14:1666–1669

    Article  PubMed  Google Scholar 

  4. Sterliński M, Przybylski A, Gepner K et al (2010) Over 10 years with an implantable cardioverter-defibrillator—a long term follow-up of 60 patients. Kardiol Pol 68(9):1023–1029

    PubMed  Google Scholar 

  5. Polewczyk A, Janion M, Kutarski A (2016) Cardiac device infections: definition, classification, differential diagnosis, and management. Pol Arch Med Wewn 126(4):275–283

    PubMed  Google Scholar 

  6. Płońska-Gościniak E, Olędzki S, Kukulski T et al (2019) Pol-CDRIE registry—1-year observational data on patients hospitalized due to cardiac device-related infective endocarditis in polish referential cardiology centres. Kardiol Pol 77(5):561–567

    Article  PubMed  Google Scholar 

  7. Habib G, Lancellotti P, Erba PA et al (2019) EURO-ENDO investigators, the ESC-EORP EURO-ENDO (european infective endocarditis) registry. Eur Heart 5(3):202–207

    Google Scholar 

  8. Polewczyk A, Jacheć W, Tomaszewski A et al (2017) Lead-related infective endocarditis: factors influencing early and long-term survival in patients undergoing transvenous lead extraction. Heart Rhythm 14(1):43–49

    Article  PubMed  Google Scholar 

  9. Maytin M, Jones SO, Epstein LM (2012) Long-term mortality after transvenous lead extraction. Circ Arrhythm Electrophysiol 5(2):252–257

    Article  CAS  PubMed  Google Scholar 

  10. Li JS, Sexton DJ, Mick N et al (2000) Proposed modifications to the duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638

    Article  CAS  PubMed  Google Scholar 

  11. Habib G, Lancellotti P, Antunes MJ et al (2015) ESC scientific document group; 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the european society of cardiology (ESC) endorsed by: european association for cardio-thoracic surgery (EACTS), the european association of nuclear medicine (EANM). Eur Heart J 36(44):3075–3128

    Article  PubMed  Google Scholar 

  12. Blomström-Lundqvist C, Traykov V, Erba PA et al (2020) European heart rhythm association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections—endorsed by the heart rhythm society (HRS), the asia pacific heart rhythmsociety (APHRS), the latin american heart rhythm society (LAHRS), international society for cardiovascular infectious diseases (ISCVID) and the european society of clinical microbiology and infectious diseases (ESCMID) in collaboration with the european association for cardio-thoracic surgery (EACTS). Europace 22:515–516

    Article  PubMed  Google Scholar 

  13. Erba PA, Lancellotti P, Vilacosta I et al (2018) Recommendations on nuclear and multimodality imaging in IE and CIED infections. Eur J Nucl Med Mol Imaging 45(10):1795–1815

    Article  PubMed  Google Scholar 

  14. Narducci ML, Pelargonio G, Russo E et al (2013) Usefulness of intracardiac echocardiography for the diagnosis of cardiovascular implantable electronic device-related endocarditis. J Am Coll Cardiol 61(13):1398–1405

    Article  PubMed  Google Scholar 

  15. Pizzi MN, Roque A, Fernández-Hidalgo N, Cuéllar-Calabria H et al (2015) Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomography angiography: initial results at an infective endocarditis referral center. Circulation 132(12):1113–1126

    Article  PubMed  Google Scholar 

  16. Marciniak-Emmons MB, Sterliński M, Syska P et al (2016) New diagnostic pathways urgently needed. protocol of PET guidance I pilot study: positron emission tomography in suspected cardiac implantable electronic device-related infection. Kardiol Pol 74(1):47–52

    Article  PubMed  Google Scholar 

  17. Habib G, Erba PA, Iung B et al (2019) EURO-ENDO Investigators, clinical presentation, aetiology and outcome of infective endocarditis. results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J 40(39):3222–3232

    Article  PubMed  Google Scholar 

  18. Habib G, Derumeaux G, Avierinos JF et al (1999) Value and limitations of the duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol 33(7):2023–2029

    Article  CAS  PubMed  Google Scholar 

  19. Dundar C, Tigen K, Tanalp C et al (2011) The prevalence of echocardiographic accretions on the leads of patients with permanent pacemakers. J Am Soc Echocardiogr 24:803–807

    Article  PubMed  Google Scholar 

  20. Downey BC, Juselius WE, Pandian NG et al (2011) Incidence and significance of pacemaker and implantable cardioverter-defibrillator lead masses discovered during transesophageal echocardiography. Pace 34:679–683

    Article  PubMed  Google Scholar 

  21. Nagarakanti S, Bishburg E, Bapat A (2020) Cardiac implantable electronic device infection: does the device need to be extracted? J Arrhythmia 36:493–497

    Article  Google Scholar 

  22. Juneau D, Golfam M, Hazra S et al (2017) Positron emission tomography and single-photon emission computed tomography imaging in the diagnosis of cardiac implantable electronic device infection: a systematic review and meta-analysis. Circ Cardiovasc Imaging 10(4):e005772

    Article  PubMed  Google Scholar 

  23. Mahmood M, Kendi AT, Ajmal S et al (2019) Meta-analysis of 18F-FDG PET/CT in the diagnosis of infective endocarditis. J Nucl Cardiol 26:922–935

    Article  PubMed  Google Scholar 

  24. Wang TKM, Sánchez-Nadales A, Igbinomwanhia E et al (2020) Diagnosis of infective endocarditis by subtype using 18F-fluorodeoxyglucose positron emission tomography/computed tomography: a contemporary meta-analysis. Circ Cardiovasc Imaging 13(6):e010600

    Article  PubMed  Google Scholar 

  25. Yan J, Zhang C, Niu Y et al (2016) The role of 18FFDG PET/CT in infectious endocarditis: a systematic review and meta-analysis. Int J Clin Pharmacol Ther 54:337–342

    Article  CAS  PubMed  Google Scholar 

  26. Farkowski MM, Milkowski M, Dziuk M et al (2014) Economical aspect of PET/CT-guided diagnosis of suspected infective endocarditis in a patient with implantable cardioverter-defibrillator. Heart Lung 43(4):341–343

    Article  PubMed  Google Scholar 

  27. Boursier C, Duval X, Mahida B et al (2021) AEPEI-TEPvENDO study group hypermetabolism of the spleen or bone marrow is an additional albeit indirect sign of infective endocarditis at FDG-PET. J Nucl Cardiol 28(6):2533–2542. https://doi.org/10.1007/s12350-020-02050-2

    Article  PubMed  Google Scholar 

  28. Hanneman K, Kadoch M, Guo HH et al (2017) Initial experience with simultaneous 18F-FDG PET/MRI in the evaluation of cardiac sarcoidosis and myocarditis. Clin Nucl Med 42(7):e328–e334. https://doi.org/10.1097/RLU.0000000000001669

    Article  PubMed  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Author notes

  1. M. B. Marciniak-Emmons and E. Świerżyńska have contributed equally to this work.

Authors and Affiliations

  1. 2nd Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska St, 04-628, Warsaw, Poland

    M. B. Marciniak-Emmons, P. Syska, M. M. Farkowski, D. Zając, A. Maciąg & M. Pytkowski

  2. 1st Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska St, 04-628, Warsaw, Poland

    E. Świerżyńska, J. Zakrzewska-Koperska, A. Oręziak, M. Bilińska, Ł. Szumowski & M. Sterliński

  3. Doctoral School, Medical University of Warsaw, 61 Zwirki i Wigury St, 02-091, Warsaw, Poland

    E. Świerżyńska

  4. Department of Nuclear Medicine, Military Institute of Medicine, 128 Szaserow St, 04-141, Warsaw, Poland

    A. Mazurek & M. Dziuk

  5. Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland

    B. Firek

  6. Affidea Mazovian PET/CT Medical Centre, 128 Szaserow St, 04-349, Warsaw, Poland

    A. Mazurek & M. Dziuk

  7. Department of Medical Biology, National Institute of Cardiology, 42 Alpejska St, 04-628, Warsaw, Poland

    U. Juszczyk

  8. Clinical Research Support Center, National Institute of Cardiology, 42 Alpejska St, 04-628, Warsaw, Poland

    I. Kowalik

  9. Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute Cardiology, 42 Alpejska St, 04-628, Warsaw, Poland

    I. Kowalik & H. Szwed

Authors
  1. M. B. Marciniak-Emmons
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Świerżyńska
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Mazurek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Syska
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. M. Farkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Firek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Juszczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Zakrzewska-Koperska
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Zając
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A. Oręziak
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. Maciąg
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. I. Kowalik
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Pytkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. H. Szwed
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. M. Bilińska
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Ł. Szumowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. M. Dziuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. M. Sterliński
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MBM-E, AM, UJ, MD, PS, MF, MS, HS, DZ, AM, MP, JZ-K, AO. The first draft of the manuscript was written by EŚ, MS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to E. Świerżyńska.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interest to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Institute of Cardiology No.IK-NP.-0021–85/1465/14.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marciniak-Emmons, M.B., Świerżyńska, E., Mazurek, A. et al. Computed tomography with positron emission tomography is more useful in local than systemic infectious process related to cardiac implanted electrotherapy device: a prospective controlled multicenter diagnostic intervention PET-Guidance Trial. Int J Cardiovasc Imaging 38, 2753–2761 (2022). https://doi.org/10.1007/s10554-022-02663-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-022-02663-3

Keywords

Search

Navigation