Diagnosis and Management of Patients with Suspected Left-sided Prosthetic Valve Endocarditis According to Cardiac FDG-PET CT Results

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ID: 328944
2026
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Abstract
Abstract Background Despite advances in echocardiography, the definitive diagnosis of prosthetic valve endocarditis (PVE) has remained difficult. 18F-fluorodeoxyglucose (FDG) positron emission computed tomography (PET) shows promise due to improved sensitivity. As such, our study explored the effects of PET findings on the diagnosis of PVE and how this additional data affected patient management decisions. Methods Between 2016 to 2022, 140 patients underwent PET to evaluate suspected left-sided PVE, resulting in 93 +PET patients and 47 -PET patients. Patients were classified as definite, possible and rejected PVE according to 2023 Duke-ISCVID guidelines, initially excluding, 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, using univariable and multivariable analyses. A qualitative analysis of medical decision-making was performed. Results Demographics were similar between groups. +PET patients had higher C-reactive protein levels (9.8 vs 3.1 mg/L, P = 0.001) and were more likely to have positive blood culture and echocardiographic findings. The addition of PET significantly increased the diagnosis of definite endocarditis (46% to 63%, P<0.001). A positive PET was positively associated with ongoing use of antibiotics after three months (OR 3.93 P=0.002) and surgical management (OR 5.99, P=0.008). 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 PET 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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Authors Juan J. Cáceres, Mark Edwards, Sarah Kurz, Barbara C S Hamilton, Chaitanya Madamanchi, Venkatesh L. Murthy, G Michael Deeb, Andrew Harris
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Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag580
URL
https://doi.org/10.1093/ofid/ofag580
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