Impact of 18F-FDG-PET-CT for extra-cardiac complications in infective endocarditis

Abstract

Extra-cardiac complications (ECCs) contribute to high mortality rates in patients with infective endocarditis (IE). Current guidelines recommend 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) as a comprehensive full-body screening for ECCs, however beneficial effect in terms of treatment interventions has yet to be evaluated. The aim of this study was to assess clinical impact of 18F-FDG-PET/CT in patients with ECCs in a larger cohort of patients with IE including a control group. A four week retrospective analysis of prospectively collected data from start of effective antibiotics was performed in a tertiary hospital in the Netherlands, including 146 patients in the PET/CT-group and 102 patients in the non-PET/CT-group. A total of 233 ECCs were found in 107 patients (73.3%) in the PET/CT-group and 107 ECCs in 68 patients (66.7%) in the non-PET/CT-group, leading to respectively 72 and 55 interventions. 18F-FDG-PET/CT performance led to reclassification of modified Duke criteria from possible to definite in 14 patients (9.6%). Performance of 18F-FDG-PET/CT led to a change of treatment in 1 in 5 patients and to 24 unnecessary investigations. No significant association was found between 18F-FDG-PET/CT and number of interventions performed in Poisson regression analysis (p=0.42). No significant difference was found in the number of interventions in patients with infective endocarditis when adding 18F-FDG-PET/CT to conventional work up, debating the role and added value 18F-FDG-PET/CT in patients with infective endocarditis. Unnecessary investigations and high costs remain challenges of 18F-FDG-PET/CT. Clinicians should be cautious of this when suggesting 18F-FDG- PET/CT for evaluation of ECCs.