Nuclear Medicine in Diagnosis of Prosthetic Valve Endocarditis: An Update

Over the past decades cardiovascular disease management has been substantially improved by the increasing introduction of medical devices as prosthetic valves. The yearly rate of infective endocarditis (IE) in patient with a prosthetic valve is approximately 3 cases per 1,000 patients. The fatality rate of prosthetic valve endocarditis (PVE) remains stable over the years, in part due to the aging of the population. The diagnostic value of echocardiography in diagnosis is operator-dependent and its sensitivity can decrease in presence of intracardiac devices and valvular prosthesis. The modified Duke criteria are considered the gold standard for diagnosing IE; their sensibility is 80%, but in clinical practice their diagnostic accuracy in PVE is lower, resulting inconclusively in nearly 30% of cases. In the last years, these new imaging modalities have gained an increasing attention because they make it possible to diagnose an IE earlier than the structural alterations occurring. Several studies have been conducted in order to assess the diagnostic accuracy of various nuclear medicine techniques in diagnosis of PVE. We performed a review of the literature to assess the available evidence on the role of nuclear medicine techniques in the diagnosis of PVE.

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The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020

Current Pharmaceutical Biotechnology ◽

10.2174/1389201021666200423110359 ◽

2020 ◽

Vol 21 (12) ◽

pp. 1140-1153 ◽

Cited By ~ 1

Author(s):

Mohammad A. Noshak ◽

Mohammad A. Rezaee ◽

Alka Hasani ◽

Mehdi Mirzaii

Keyword(s):

Foreign Body ◽

Infective Endocarditis ◽

Prosthetic Valve ◽

Human Life ◽

Prosthetic Valve Endocarditis ◽

Surgical Site Infections ◽

Coagulase Negative Staphylococci ◽

Native Valve ◽

Native Valve Endocarditis

Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.

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Infective endocarditis caused by HACEK group bacteria—a registry-based comparative study

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-021-04240-3 ◽

2021 ◽

Author(s):

Anna Bläckberg ◽

Christian Morenius ◽

Lars Olaison ◽

Andreas Berge ◽

Magnus Rasmussen

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Mortality Rate ◽

Haemophilus Influenzae ◽

Comparative Study ◽

Clinical Characteristics ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Common Cause ◽

Prosthetic Valves

AbstractInfective endocarditis (IE) caused by bacteria within Haemophilus (excluding Haemophilus influenzae), Aggregatibacter, Cardiobacterium, Eikenella and Kingella (HACEK) is rare. This study aimed to describe clinical features of IE caused by HACEK genera in comparison with IE due to other pathogens. Cases of IE due to HACEK were identified through the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of IE cases caused by HACEK were compared with cases of IE due to other pathogens reported to the same registry. Ninety-six patients with IE caused by HACEK were identified, and this corresponds to 1.8% of all IE cases. Eighty-three cases were definite endocarditis, and the mortality rate was 2%. The median age was 63 years, which was lower compared to patients with IE caused by other pathogens (66, 70 and 73 years respectively, p ≤ 0.01). Patients with IE caused by Haemophilus were younger compared to patients with IE due to Aggregatibacter (47 vs 67 years, p ≤ 0.001). Patients with IE due to HACEK exhibited longer duration from onset of symptoms to hospitalization and had more prosthetic valve endocarditis compared to patients with IE due to Staphylococcus aureus (10 vs 2 days, p ≤ 0.001, and 35 vs 14%, p ≤ 0.001). This is, to date, the largest study on IE due to HACEK. Aggregatibacter was the most common cause of IE within the group. The condition has a subacute onset and often strikes in patients with prosthetic valves, and the mortality rate is relatively low.

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Prognostic Role of Paravalvular Spread on Computed Tomography in Suspected Prosthetic Valve Endocarditis

Journal of Thoracic Imaging ◽

10.1097/rti.0000000000000598 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Gurmandeep S. Sandhu ◽

Pratik S. Velangi ◽

Harmeet Kharoud ◽

Prabhjot S. Nijjar

Keyword(s):

Computed Tomography ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Prognostic Role

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Prosthetic valve endocarditis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0392 ◽

2018 ◽

pp. 1720-1723

Author(s):

José A. San Román ◽

Javier López

Keyword(s):

Computed Tomography ◽

Infective Endocarditis ◽

Antibiotic Treatment ◽

Prosthetic Valve ◽

Photon Emission ◽

Clinical Manifestations ◽

Prosthetic Valve Endocarditis ◽

Native Valve ◽

Native Valve Endocarditis ◽

Duke Criteria

Prosthetic valve endocarditis (PVE) complicates the clinical course of 1–6% of patients with prosthetic valves and it is one of the types of infective endocarditis with the worst prognosis. In early-onset PVE (that occurs within the first year after surgery), the microbiological profile is dominated by staphylococci. In late-onset PVE, the microorganisms are similar to native valve endocarditis. Clinical manifestations are very variable and depend on the causative microorganism. The diagnosis is established with the modified Duke criteria although they yield lower diagnostic accuracy than in native valve endocarditis. Transoesophageal echocardiography is the main imaging technique in everyday clinical practice in PVE as the sensitivity is higher than transthoracic echocardiography. The findings of other techniques, as cardiac computed tomography (CT), positron emission tomography/CT, or single-photon emission computed tomography/CT have been recently recognized as new major diagnostic criteria and can be very useful in cases with a high level of clinical suspicion and negative echocardiography. Empirical antibiotic treatment should cover the most frequent microorganisms, especially staphylococci. Once the microbiological diagnosis is made, the antibiotic treatment is similar to native valve infective endocarditis, except for the addition of rifampicin in staphylococcal PVE and a longer length (up to 6 weeks) of the treatment. Surgical indications are also similar to native valve endocarditis, heart failure being the most common and embolic prevention the most debatable. Prognosis is bad, and during the follow-up, a team experienced with endocarditis is needed. Patients with a history of PVE should receive antibiotic prophylaxis if they undergo invasive dental manipulations.

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Interventional Echocardiography of the MV: What the Interventionalist Wants to Know

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253218778822 ◽

2018 ◽

Vol 23 (1) ◽

pp. 37-47 ◽

Cited By ~ 2

Author(s):

Ludmil Mitrev ◽

Nayan Desai ◽

Ahmed Awad ◽

Sajjad Sabir

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

The Past ◽

Interventional Echocardiography ◽

Valve In Valve ◽

Procedural Guidance ◽

Valve Implantation ◽

Transcatheter Interventions

The past 2 decades have seen a proliferation of transcatheter mitral valve (MV) therapies, which are less invasive and distinct from surgical MV repair or replacement. The commonly used MV transcatheter therapies include (1) percutaneous mitral balloon commissurotomy (PMBC) for rheumatic mitral stenosis; (2) edge-to-edge repair with the MitraClip for mitral regurgitation; (3) valve-in-valve implantation in bioprosthetic MV, native MV, or mitral ring; and (4) closure of paravalvular leaks (PVLs). This article will focus on the use of echocardiography in the diagnosis, patient selection, procedural guidance, and postprocedural follow-up for PMBC, with notes on the role of transesophageal echocardiography in transcatheter interventions for prosthetic valve degeneration and PVL closure.

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Role of PET in Diagnosis and Risk Assessment in Patients with Known or Suspected CAD

10.1093/med/9780199392094.003.0020 ◽

2015 ◽

Cited By ~ 1

Author(s):

Brian A. Mc Ardle ◽

Jennifer M. Renaud ◽

Robert A. deKemp ◽

Rob S. B. Beanlands

Keyword(s):

Myocardial Perfusion ◽

Diagnostic Accuracy ◽

Lower Cost ◽

Image Artifacts ◽

Cardiac Pet ◽

The Past ◽

Pet Myocardial Perfusion Imaging ◽

Patient Radiation Exposure ◽

And Function

Cardiac PET enables evaluation of multiple aspects of myocardial perfusion, metabolism, cell signaling and function that are of value both for diagnosis and prognostication in patients with known or suspected CAD and its use has increased in the past three decades. PET myocardial perfusion imaging (MPI) offers several technological advantages over SPECT including; higher photon energy, higher count sensitivity, more consistent attenuation correction and the ability to measure myocardial blood flow in absolute terms. These result in faster imaging times, lower patient radiation exposure and increased diagnostic accuracy. However the availability of PET MPI remains limited, predominantly due to expense. Efforts are underway to expand the use of PET MPI beyond larger centers, with lower-cost scanners and more widely available radiotracers. In this chapter we describe the latest advances in PET camera technology and image reconstruction as well as potential image artifacts specific to PET MPI. We go on to discuss diagnostic accuracy and prognostic value of PET MPI as well as its role in clinical practice.

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Is Rifampin Use Associated With Better Outcome in Staphylococcal Prosthetic Valve Endocarditis? A Multicenter Retrospective Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1040 ◽

2020 ◽

Author(s):

Audrey Le Bot ◽

Raphaël Lecomte ◽

Pierre Gazeau ◽

François Benezit ◽

Cédric Arvieux ◽

...

Keyword(s):

Prosthetic Valve ◽

Outcome Measurement ◽

Prosthetic Valve Endocarditis ◽

Hospital Length Of Stay ◽

Coagulase Negative Staphylococci ◽

Valvular Surgery ◽

Duke Criteria ◽

One Year ◽

The Impact ◽

Relapse Rates

Abstract Background International guidelines recommend rifampin-based combinations for staphylococcal prosthetic valve endocarditis (PVE). However, no robust clinical data support this recommendation, and rifampin tolerability is an issue. We aimed to evaluate the impact of rifampin for the treatment of staphylococcal PVE. Methods An observational retrospective cohort study of all adults with staphylococcal PVE (modified Duke criteria) was conducted in 3 referral centers for endocarditis, during years 2000–2018. Primary outcome measurement was 1-year mortality. Results We enrolled 180 patients with PVE due to Staphylococcus aureus (n = 114, 63.3%), or coagulase-negative staphylococci (n = 66, 36.7%), on bioprosthesis (n = 111, 61.7%), mechanical valve (n = 67, 37.2%), or both (n = 2). There were 132 males (73.3%), and mean age was 70.4 ± 12.4 years. Valvular surgery was performed in 51/180 (28.3%) cases. Despite all isolates were susceptible to rifampin, only 101 (56.1%) were treated with rifampin, for a median duration of 33.0 days, whereas 79 (43.9%) received no rifampin. Baseline characteristics were similar in both groups. One-year mortality was, respectively, 37.6% (38/101), and 31.6% (25/79), in patients treated with, or without, rifampin (P = .62). Relapse rates were 5.9% (6/101), and 8.9% (7/79), P = .65. Patients treated with rifampin had longer hospital length-of-stay: 42.3 ± 18.6 vs 31.3 ± 14.0 days (P < .0001). On multivariate analysis, only cerebral emboli (odds ratio [OR] 2.95, 95% confidence interval [CI], 1.30–6.70, P = .009), definite endocarditis (OR 7.15, 95% CI, 1.47–34.77, P = .018), and methicillin-resistant S. aureus (OR 6.04, 95% CI, 1.34–27.26, P = .019), were associated with 1-year mortality. Conclusions A large proportion (43.9%) of staphylococcal PVE received no rifampin. One-year survival and relapse rates were similar in patients treated with or without rifampin.

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Actinomyces naeslundii: An Uncommon Cause of Endocarditis

Case Reports in Infectious Diseases ◽

10.1155/2015/602462 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Christopher D. Cortes ◽

Carl Urban ◽

Glenn Turett

Keyword(s):

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

First Report ◽

The Past ◽

Actinomyces Naeslundii

Actinomycesrarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE) caused byActinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused byActinomyces.

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