Key result
Positive FDG-PET scan linked to ~6-fold higher odds of cardiac surgery within 3 months.
Why the study?
Despite advances in echocardiography, the definitive diagnosis of prosthetic valve endocarditis remains difficult, and the impact of cardiac FDG-PET CT on diagnosis and management needed exploration.
Does a positive FDG-PET scan influence clinical management and outcomes such as surgical intervention and antibiotic duration in patients with suspected left-sided prosthetic valve endocarditis?
Cohort (n=140)
No
Does a positive FDG-PET scan influence clinical management and outcomes such as surgical intervention and antibiotic duration in patients with suspected left-sided prosthetic valve endocarditis?
Odds Ratio: 5.99 (95% CI 1.6–22.4)
Absolute Event Rate: 40% vs 6.4%
p-value: p=0.008
FDG-PET results significantly influenced multidisciplinary management of prosthetic valve endocarditis, particularly regarding surgical referral and antibiotic duration.
Positive FDG-PET may inform surgical referral and antibiotic duration in suspected prosthetic valve endocarditis; extends Duke-ISCVID criteria but leaves open effects on outcomes.
Background Despite advances in echocardiography, the definitive diagnosis of prosthetic valve endocarditis (PVE) remains difficult. 18F-fluorodeoxyglucose (chemical name 2-deoxy-2-[18F]fluro-D-glucose) positron emission tomography (PET) shows promise with improved sensitivity. Our study explored the effects of PET findings on the diagnosis of PVE and patient management decisions. Method Between 2016 and 2022, 140 patients underwent PET to evaluate suspected left-sided PVE, resulting in 93 patients with positive PET (+PET) and 47 patients with negative PET. Patients were classified as definite, possible, or rejected PVE according to the 2023 Duke-International Society for Cardiovascular Infectious Diseases guidelines, initially excluding and then including PET results. We evaluated the association between PET results and clinical outcomes such as duration of antibiotics, performance of cardiac surgery within 3 months, and long-term mortality. A qualitative analysis of medical decision-making was performed. Results Demographics were similar between groups. patients with +PET had higher C-reactive protein levels (9.8 vs 3.1 mg/L, P = .001) and were more likely to have positive blood culture and echocardiographic findings. The addition of PET significantly increased the diagnosis of definite endocarditis (46%–63%, P < .001). A +PET was positively associated with ongoing use of antibiotics after 3 months (odds ratio [OR] 3.93, P = .002) and surgical management (OR 5.99, P = .008). Based on qualitative review of medical decision-making, PET influenced management in 88 patients (63%), supporting longer duration of antibiotics in 22%, surgical management in 8.6%, and shorter duration of antibiotics in 11% of patients. Conclusions Positron emission tomography results, when incorporated into multidisciplinary discussion, aided in a more definitive diagnosis of PVE and influenced management in the majority of patients.
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Kurz et al. (2026) conducted a cohort in Suspected left-sided prosthetic valve endocarditis (n=140). Positive FDG-PET vs. Negative FDG-PET was evaluated on Cardiac surgery within 3 months (OR 5.99, 95% CI 1.60-22.4, p=0.008). A positive FDG-PET scan was significantly associated with a higher likelihood of surgical management within 3 months (OR 5.99) and ongoing use of antibiotics after 3 months.
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