18F-FDG PET CT in cardiac device infections - A Case series

Document Type : Case Series

Authors

Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Science, Kochi, Kerala, India

10.22038/aojnmb.2024.77504.1547

Abstract

With the increasing number of interventional cardiology procedures, the number of cardiac device infections (including pacemakers, prosthetic valves, coronary and aortic stents) have also increased. These infections can cause significant morbidity and can even lead to mortality if not managed promptly. If suspected clinically the first-line imaging modality is Trans-Thoracic Echocardiography, while Transesophageal Echocardiography is also used in selected cases. The confirmation of a cardiac device infection is mostly done with the help of blood or pus culture. Even though Echocardiography is a very efficient technique for the evaluation of the heart, it cannot differentiate infection from thrombus or fibrosis. With the increasing availability of Positron Emission Tomography CT (PET CT) machines worldwide, the use of 18F-FDG PET CT for infection imaging has gained traction, especially for cardiac device infection. Most of the recent studies show a good diagnostic accuracy of 18F-FDG PET CT with many of the recent diagnostic and management guidelines now acknowledging its role, especially in equivocal cases. We present six such cases where 18F-FDG PET CT provided valuable information either for diagnosis, confirming the presence of infection, delineating extent, therapy response or sometimes even helping appropriate treatment decision making in patients with suspected cardiac device infection.

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  1. Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009--a World Society of Arrhythmia's project. Pacing Clin Electrophysiol. 2011; 34(8):1013-27.
  2. Kumar B, Prakash J, Kumari S, Manjunath CN. Trends in Permanent Pacemaker Implantation in Indian Population: A Single Centre Experience. Journal of Clinical & Diagnostic Research. 2018; 12(12).
  3. Arramraju SK, Koganti S, Janapati R, Emmareddy SK, Mandala GR. The report on the Indian coronary intervention data for the year 2017-National Interventional Indian Heart J. 2019; 71(2):146-148.
  4. Palmeri NO, Kramer DB, Karchmer AW, Zimetbaum PJ. A Review of Cardiac Implantable Electronic Device Infections for the Practicing Electrophysiologist. JACC Clin Electrophysiol. 2021; 7(6):811-824.
  5. Gitenay E, Molin F, Blais S, Tremblay V, Gervais P, Plourde B, et al. Cardiac Implantable Electronic Device Infection: Detailed Analysis of Cost Implications. Can J Cardiol. 2018; 34(8):1026-1032.
  6. Sohail MR, Eby EL, Ryan MP, Gunnarsson C, Wright LA, Greenspon AJ. Incidence, treatment intensity, and incremental annual expenditures for patients experiencing a cardiac implantable electronic device infection: evidence from a large US payer database 1-year post implantation. Circulation: Arrhythmia and Electrophysiology. 2016; 9(8): e003929.
  7. Greenspon AJ, Eby EL, Petrilla AA, Sohail MR. Treatment patterns, costs, and mortality among Medicare beneficiaries with CIED infection. Pacing and Clinical Electrophysiology. 2018; 41(5):495-503.
  8. Uslan DZ, Sohail MR, St Sauver JL, et al. Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med. 2007; 167 (7):669–675.
  9. Chambers ST. Diagnosis and management of staphylococcal infections of pacemakers and cardiac defibrillators. Intern Med J. 2005; 35 Suppl 2:S63–71.
  10. Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH 3rd, et al. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm. 2009; 6(7):1085-104.
  11. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010; 121(3):458-77.
  12. Sandoe JA, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, et al. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother. 2015; 70(2):325-59.
  13. Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017; 14(12): e503-e551.
  14. Wang TK, Bin Saeedan M, Chan N, Obuchowski NA, Shrestha N, Xu B, et al. Complementary diagnostic and prognostic contributions of cardiac computed tomography for infective endocarditis Circulation: Cardiovascular Imaging. 2020; 13(9):e011126.
  15. Chen W, Kim J, Molchanova-Cook OP, Dilsizian V. The potential of FDG PET/CT for early diagnosis of cardiac device and prosthetic valve infection before morphologic damages ensue. Current cardiology 2014; 16:1-8.
  16. Maytin M, Wilkoff BL, Brunner M, Cronin E, Love CJ, Bongiorni MG, et al. Multi center experience with extraction of the Riata/Riata ST ICD lead. Heart Rhythm. 2014; 11(9):1613-8.
  17. Suryawan IGR, Luke K, Agustianto RF, Mulia EPB. Coronary stent infection: a systematic review. Coron Artery Dis. 2022; 33(4):318-326.
  18. Elieson M, Mixon T, Carpenter J. Coronary stent infections: a case report and literature review. Tex Heart Inst J. 2012; 39(6):884-9.
  19. Greenspon AJ, Patel JD, Lau E, Ochoa JA, Frisch DR, Ho RT, et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol. 2011; 58(10):1001-6.
  20. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 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). European heart journal. 2015; 36(44):3075-128.
  21. Juneau D, Golfam M, Hazra S, Zuckier LS, Garas S, Redpath C, et al. 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. Circulation: Cardiovascular Imaging. 2017; 10(4):e005772.
  22. Nuvoli S, Fiore V, Babudieri S, Galassi S, Bagella P, Solinas P, et al. The additional role of 18F-FDG PET/CT in prosthetic valve endocarditis. Eur Rev Med Pharmacol Sci. 2018; 22(6):1744-1751.
  23. Pizzi MN, Roque A, Fernández-Hidalgo N, Cuéllar-Calabria H, Ferreira-González I, Gonzàlez-Alujas MT, et al. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomo-graphy angiography: initial results at an infective endocarditis referral center. Circulation. 2015; 132(12):1113-26.
  24. Sarrazin JF, Philippon F, Tessier M, Guimond J, Molin F, Champagne J, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. Journal of the American College of Cardiology. 2012; 59(18):1616-25.
  25. Kobayashi Y, Kumita S, Fukushima Y, Ishihara K, Suda M, Sakurai M. Significant suppression of myocardial (18)F-fluorodeoxyglucose uptake using 24-h carbohydrate restriction and a low-carbohydrate, high-fat diet. J Cardiol. 2013; 62(5):314-9.
  26. Scholtens AM, van den Berk AM, van der Sluis NL, Esser JP, Lammers GK, de Klerk JMH, et al. Suppression of myocardial glucose metabolism in FDG PET/CT: impact of dose variation in heparin bolus pre-administration. Eur J Nucl Med Mol Imaging. 2020; 47(11):2698-2702.
  27. Dilsizian V, Budde RPJ, Chen W, Mankad SV, Lindner JR, Nieman K. Best Practices for Imaging Cardiac Device-Related Infections and Endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging. 2022; 15(5):891-911.