Key result
Multimodality imaging techniques such as leukocyte scintigraphy, FDG-PET, MDCTA, and CMRI can provide additional diagnostic value and aid in the correct diagnosis of prosthetic valve endocarditis.
Why the study?
In prosthetic valve endocarditis, echocardiography can be normal or non-diagnostic in a high proportion of cases, leading to decreased sensitivity for the modified Duke criteria.
Do multimodality imaging techniques improve diagnostic accuracy in patients with suspected prosthetic valve endocarditis?
Do multimodality imaging techniques improve diagnostic accuracy in patients with suspected prosthetic valve endocarditis?
Multimodality imaging techniques such as FDG-PET and MDCTA hold promise in augmenting standard echocardiography to improve diagnostic accuracy in prosthetic valve endocarditis.
Requires cautious MDC interpretation in PVE; extends evidence for multimodality imaging integration in future criteria.
Infective endocarditis is a common and treatable condition that carries a high mortality rate. Currently the workup of infective endocarditis relies on the integration of clinical, microbiological and echocardiographic data through the use of the modified Duke criteria (MDC). However, in cases of prosthetic valve endocarditis (PVE) echocardiography can be normal or non-diagnostic in a high proportion of cases leading to decreased sensitivity for the MDC. Evolving multimodality imaging techniques including leukocyte scintigraphy (white blood cell imaging), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), multidetector computed tomographic angiography (MDCTA), and cardiac magnetic resonance imaging (CMRI) may each augment the standard workup of PVE and increase diagnostic accuracy. While further studies are necessary to clarify the ideal role for each of these imaging techniques, nevertheless, these modalities hold promise in determining the diagnosis, prognosis, and care of PVE. We start by presenting a clinical vignette, then evidence supporting various modality strategies, balanced by limitations, and review of formal guidelines, when available. The article ends with the authors' summary of future directions and case conclusion.
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Eder et al. (2021) conducted a review in Prosthetic Valve Endocarditis. Multimodality imaging (Leukocyte scintigraphy, FDG-PET, MDCTA, CMRI) vs. Standard diagnostic workup (Echocardiography and Modified Duke Criteria) was evaluated. Multimodality imaging techniques such as leukocyte scintigraphy, FDG-PET, MDCTA, and CMRI can provide additional diagnostic value and aid in the correct diagnosis of prosthetic valve endocarditis.
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