18F-FDG-PET/CT leads to improved source control of extra-cardiac complications in infective endocarditis

Abstract

Abstract Introduction Extra-cardiac complications (ECCs) contribute to morbidity and mortality in patients with infective endocarditis (IE). Current guidelines recommend 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) as a screening tool for ECCs. This study assessed the clinical impact of ECCs detected by 18F-FDG-PET/CT compared to conventional diagnostics in patients with suspected IE. Methods Patients with possible or definite IE (ESC 2015 criteria) were prospectively enrolled in the Amsterdam UMC endocarditis team registry from October 2016 till March 2021. The primary outcome, the number of source control interventions (SCIs), was analyzed using Cox regression analyses extended for recurrent events, with 18F-FDG-PET/CT as a time-dependent covariate. Secondary outcomes included the crude number needed to scan to perform one additional SCI, predictors associated with SCIs, and 90-day all-cause mortality adjusted for both immortal time bias and confounders. Results We included 252 patients, 152 in the 18F-FDG-PET/CT group and 100 in the control group. In the control group, 18 SCIs were performed. In the 18F-FDG-PET/CT group, 57 SCIs were performed, of which 21 were prompted by 18F-FDG-PET/CT findings. The crude number needed to scan leading to one additional SCI was 8 (95% CI 6-15). 18F-FDG-PET/CT was associated with the number of SCIs, with an adjusted hazard ratio of 2.96 (95% CI 1.36-6.44). No variables were significantly associated with 18F-FDG-PET/CT-related SCI. No differences were found in mortality between the control and PET/CT group (HR 0.69, 95% CI 0.40-1.20). Conclusion The use of 18F-FDG-PET/CT among patients with suspected IE leads to increased source control interventions for ECCs.