The [ 99m Tc]Tc-HMPAO-labelled white blood cell SPECT/CT as a novel criterion for infective endocarditis diagnosis.

Autor: Holcman K; Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland. Electronic address: katarzyna.holcman@uj.edu.pl., Ząbek A; Jagiellonian University Medical College, Department of Electrocardiology, John Paul II Hospital, Krakow, Poland., Boczar K; Jagiellonian University Medical College, Department of Electrocardiology, John Paul II Hospital, Krakow, Poland., Rubiś P; Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland., Ćmiel B; AGH University of Science and Technology, Faculty of Applied Mathematics, Krakow, Poland., Szot W; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland; Jagiellonian University Medical College, Department of Hygiene and Dietetics, Krakow, Poland., Stępień A; Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland., Graczyk K; Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland., Podolec P; Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland., Kostkiewicz M; Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Dec 15; Vol. 417, pp. 132545. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1016/j.ijcard.2024.132545
Abstrakt: Aims: Infective endocarditis (IE) poses a significant clinical challenge, necessitating nuanced diagnostic tools for early and accurate detection. The diagnostic role of the hybrid technique of single-photon emission tomography-computed tomography with technetium-99 m-hexamethylpropyleneamine oxime-labelled leukocytes ([ 99m Tc]Tc-HMPAO-SPECT/CT) has evolved in recent years. This single-center study assessed whether the recent inclusion in the 2023 European Society of Cardiology modified diagnostic criteria of IE (2023 ESC) of infectious lesions detected with [ 99m Tc]Tc-HMPAO-SPECT/CT affects their diagnostic performance.
Methods and Results: Between 2015 and 2019, we enrolled 205 consecutive adults with suspected IE. All participants underwent [ 99m Tc]Tc-HMPAO-SPECT/CT scans (370-740 MBq). Scans were deemed positive in the presence of intracardiac abnormal tracer uptake and/or within the cardiac implantable electronic device. Patients were prospectively followed-up for 12 ± 10 months. Local device infection (LDI) or IE was diagnosed in 75 (36.6 %) patients, while 72 (35.1 %) [ 99m Tc]Tc-HMPAO-SPECT/CT results returned positive. Moreover, extracardiac infectious foci were detected in 25 % of [ 99m Tc]Tc-HMPAO-SPECT/CT scans. The inclusion of both intracardiac and extracardiac lesions detected with [ 99m Tc]Tc-HMPAO-SPECT/CT yields significantly higher sensitivity (p = 0.003) and negative predictive value (NPV) (p = 0.009).
Conclusion: The inclusion of [ 99m Tc]Tc-HMPAO-SPECT/CT into the IE diagnostic work-up improves the appropriate classification of patients. For patients with IE, the extended inclusion of lesions detected with [ 99m Tc]Tc-HMPAO-SPECT/CT in the ESC 2023 diagnostic criteria significantly improves sensitivity and NPV while reducing potential IE misdiagnoses. This pioneering imaging modality is poised to become an integral component of clinical practice, promising to advance IE diagnosis and management.
Competing Interests: Declaration of competing interest The authors have no relevant conflicts of interest to disclose.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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