Infective Endocarditis
Conditions
Keywords
Infective endocarditis, 18-FDG PET/CT, Impact, Patient's management, Diagnostic
Brief summary
The purpose of this study is to assess the impact of 18-FDG positron emission tomography (PET)/computed tomography (CT) imaging in the management of patients with suspected or proven IE in detecting cardiac valve damages and other extracardiac complications. The study will evaluate whether this procedure can change the clinical decisions (treatments, valve surgery, patients' overall care) and modify the diagnosis of IE.
Detailed description
Introduction: Infective endocarditis (IE) is a rare disease, often difficult to diagnose with a high mortality rate. Extra-cardiac manifestations, which can occur in 30 to 80% of cases, impact the outcome of the disease. Identifying these manifestations may help confirm an uncertain diagnosis and optimize patients' management. 18-FDG PET/CT imaging, widely used for cancer staging, may also detect hyper-metabolic areas related to extracardiac infectious complications of IE. It provides the opportunity to detect all extracardiac IE infectious complications through a single examination. The impact of 18-FDG PET/CT imaging on the management of IE has yet to be completely evaluated. Hypothesis: 18-FDG PET/CT implementation could result in both shortening of the initial diagnostic work-up of IE and therapeutic optimization. Primary objective: To evaluate the impact of 18-FDG PET/CT on patients' management, as measured by changes in IE therapeutic plans. Secondary objectives: * To evaluate the impact of 18-FDG PET/CT on the Duke-Li criteria for IE diagnosis * To evaluate the performance of 18-FDG PET/CT in detecting valve damages and extracardiac complications induced by the IE * To evaluate whether 18-FDG PET/CT may help identify the infection's portal of entry * To evaluate whether the detection of extracardiac complications by FDG PET/CT is associated with the 6-months survival rate * To identify clinical and biological determinants of extracardiac IE localizations and prognosis * To determine the inter-reader interpretation of the18-FDG PET/CT results and the reproducibility in preparation and acquisition method
Interventions
PROCEDURE18-FDG PET/CT scan
Whole body 18-FDG PET/CT to assess cardiac and extracardiac complications in infective endocarditis
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subjects aged ≥ 18 years 2. Presenting IE Duke-Li definite - Duke-Li possible or strong suspicion of IE Duke-Li not definite or possible, with initiation of IE antibiotic therapy. 3. Transthoracic or transesophageal ultrasound performed. 4. A stable clinical condition which does not require immediate surgery or contraindicate patient mobilization 5. Absence of cardiac surgery for the current IE episode 6. Covered by the French health insurance system 7. Having given and signed the written study informed consent to the study.
Exclusion criteria
1. Patient having already had a 18-FDG PET/CT in the current episode 2. Contraindication to perform a 18-FDG PET/CT 3. Early prosthetic valve IE (cardiac surgery within last 2 months) 4. Inability to understand the information form 5. Pregnant or lactating woman. 6. Cardiac surgery between inclusion and 18-FDG PET/CT 7. Participation to any clinical trial including 18-FDG PET/CT
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with a change in IE therapeutic plan | 7 days | at least one modification in antimicrobial or anticoagulant therapy (types, route, dose, number, duration, indication…) or any modification of surgery (type, timing, indications…) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with Duke-Li classification modifications | 6 months | Proportion of patients with change in diagnostic classification of IE (definite, possible, excluded) according to the Duke-Li classification |
| Performances of 18-FDG PET/CT in detection of IE localization as compared to other usual procedures | 6 months | 1/ in detecting valve damages and extracardiac complications and 2/ in identify the portal of entry of IE |
| 6-month mortality rate | 6 months | number of dead patients 6 months after inclusion |
| Determinants of change in therapeutic plan as defined in primary outcome | 6 months | Clinical and biological determinants of therapeutic changes |
| 18-FDG PET/CT inter-reader reproducibility | 6 months | questionnaire |
Countries
France
Outcome results
None listed