Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

Abstract

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.

Incidence and Predictors of Infections and All-Cause Death in Patients with Cardiac Implantable Electronic Devices: The Italian Nationwide RI-AIAC Registry

“…Rate of infections is usually ≤2%, but such event has an important impact on the clinical management of patients, with high healthcare-associated costs, prolonged hospitalisation and a high rate of mortality events (~20%) [5][6][7][8][9]. It is already known that, in determining the pathophysiological mechanism of the onset of CIEDs infection, various risk factors are involved, both clinical and procedural [10][11][12][13][14][15][16][17][18].…”

An easy and practical guide for imaging infection/inflammation by [18F]FDG PET/CT

“…The need of well standardized protocols for acquisition and interpretation of [ 18 F]FDG PET/CT images in this field, has become essential amongst the Nuclear Medicine community, as demonstrated by the increasing number of consensus documents and proposed interpretation criteria that have been published, for example, for imaging of prosthetic joint infections [ 20 – 24 ], diabetic foot osteomyelitis [ 25 – 27 ], cardiovascular inflammations and infections [ 18 , 28 – 34 ], spondylodiscitis [ 35 ], inflammatory bowel diseases [ 36 ] and, more recently, for imaging with [ 18 F]FDG by PET/Magnetic Resonance Imaging (MRI) [ 37 , 38 ].…”

Characteristics of infective endocarditis in a cancer population

“…36 The use of fluoro-18-fluorodeoxyglucose positron emission tomography/CT and radiolabeled WCC scintigraphy has been explored to identify underlying infectious valvular foci, although the diagnostic utility of these imaging techniques appears to be greatest with suspected prosthetic valve and cardiac implantable electronic device (CIED) endocarditis. 37 Endocarditis frequently is believed to originate from cutaneous portals of entry into the bloodstream. 30 The most common healthcare-associated causes of cutaneous portals are vascular access and implantable cardiac devices and prosthetic valves.…”