Contribution of PET imaging to mortality risk stratification in candidates to lead extraction for pacemaker or defibrillator infection: a prospective single center study
Contribution of PET imaging to mortality risk stratification in candidates to lead extraction for pacemaker or defibrillator infection: a prospective single center study
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DOI：
10.1007/s00259-018-4142-9
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发表时间：
2019-01-01
影响因子：
9.1
通讯作者：
Boriani, Giuseppe
中科院分区：
文献类型：
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作者：
Diemberger, Igor;Bonfiglioli, Rachele;Boriani, Giuseppe
目的F-18FDGPET/CT是诊断心脏植入性电子设备感染(CIEDI)的新兴技术。尽管经静脉引流(TLE)技术有了改善，但CIEDI患者的长期存活率很低。本研究的目的是评估在F-18-FDG PET/CT上扩展CIEDI是否可以改善TLE后生存的预测。方法前瞻性、单中心观察性研究，招募连续的TLE候选患者来诊断CIEDI。所有患者在TLE前均行F-18-FDG PET/CT检查。结果连续入选105例CIEDI患者。56例患者的F-18-FDG摄取增加局限于心脏可植入电子装置(CIED)袋，40例患者为全身受累。在接受长期抗菌治疗的患者中，有9例PET呈阴性(22.514.0天vs.8.6+/-13.0天；p=0.005)。采用改良Duke标准的F-18-FDGPET/CT可使23.8%的患者重新分类。平均随访25.0+/-9.0个月，死亡31例(29.5%)。在F-18-FDGPET/CT上有CIED口袋受累的患者，无论是否有全身受累，患者的存活率都较高(HR 0.493，95%CI 0.240-0.984；p=0.048)。整合F-18-FDG PET/CT数据后，CIEDI和肾小球滤过率(GFR)无明显/隐蔽受累
Purpose F-18-FDG PET/CT is an emerging technique for diagnosis of cardiac implantable electronic devices infection (CIEDI). Despite the improvements in transvenous lead extraction (TLE), long-term survival in patients with CIEDI is poor. The aim of the present study was to evaluate whether the extension of CIEDI at F-18-FDG PET/CT can improve prediction of survival after TLE.Methods Prospective, monocentric observational study enrolling consecutive candidates to TLE for a diagnosis of CIEDI. F-18-FDG PET/CT was performed in all patients prior TLE.Results There were 105 consecutive patients with confirmed CIEDI enrolled. An increased F-18-FDG uptake was limited to cardiac implantable electrical device (CIED) pocket in 56 patients, 40 patients had a systemic involvement. We had nine negative PET in patients undergoing prolonged antimicrobial therapy (22.514.0 days vs. 8.6 +/- 13.0 days; p = 0.005). Implementation of F-18-FDG PET/CT in modified Duke Criteria lead to reclassification of 23.8% of the patients. After a mean follow-up of 25.0 +/- 9.0 months, 31 patients died (29.5%). Patients with CIED pocket involvement at F-18-FDG PET/CT presented a better survival independently of presence/absence of systemic involvement (HR 0.493, 95%CI 0.240-0.984; p = 0.048). After integration of F-18-FDG PET/CT data, absence of overt/hidden pocket involvement in CIEDI and a (glomerular filtration rate) GFR