TY - JOUR
T1 - 18F-FDG PET/CT in left ventricular assist device infections
T2 - In-depth characterization and clinical implications
AU - Devesa, Ana
AU - Rashed, Eman
AU - Moss, Noah
AU - Robson, Philip M.
AU - Pyzik, Renata
AU - Roldan, Julie
AU - Taimur, Sarah
AU - Rana, Meenakshi M.
AU - Ashley, Kimberly
AU - Young, Anna
AU - Patel, Gopi
AU - Mahmood, Kiran
AU - Mitter, Sumeet S.
AU - Lala, Anuradha
AU - Barghash, Maya
AU - Fox, Arieh
AU - Correa, Ashish
AU - Pirlamarla, Preethi
AU - Contreras, Johanna
AU - Parikh, Aditya
AU - Mancini, Donna
AU - Jacobi, Adam
AU - Ghesani, Nasrin
AU - Gavane, Somali C.
AU - Ghesani, Munir
AU - Itagaki, Shinobu
AU - Anyanwu, Anelechi
AU - Fayad, Zahi A.
AU - Trivieri, Maria Giovanna
N1 - Publisher Copyright:
© 2023 International Society for the Heart and Lung Transplantation
PY - 2024/4
Y1 - 2024/4
N2 - Background: Previous retrospective studies suggest a good diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/computed tomography (CT) in left ventricular assist device (LVAD) infections. Our aim was to prospectively evaluate the role of PET/CT in the characterization and impact on clinical management of LVAD infections. Methods: A total of 40 patients (aged 58 [53-62] years) with suspected LVAD infection and 5 controls (aged 69 [64-71] years) underwent 18F-FDG-PET/CT. Four LVAD components were evaluated: exit site and subcutaneous driveline (peripheral), pump pocket, and outflow graft. The location with maximal uptake was considered the presumed site of infection. Infection was confirmed by positive culture (exit site or blood) and/or surgical findings. Results: Visual uptake was present in 40 patients (100%) in the infection group vs 4 (80%) control subjects. For each individual component, the presence of uptake was more frequent in the infection than in the control group. The location of maximal uptake was most frequently the pump pocket (48%) in the infection group and the peripheral components (75%) in the control group. Maximum standard uptake values (SUVmax) were higher in the infection than in the control group: SUVmax (average all components): 6.9 (5.1-8.5) vs 3.8 (3.7-4.3), p = 0.002; SUVmax (location of maximal uptake): 10.6 ± 4.0 vs 5.4 ± 1.9, p = 0.01. Pump pocket infections were more frequent in patients with bacteremia than without bacteremia (79% vs 31%, p = 0.011). Pseudomonas (32%) and methicillin-susceptible Staphylococcus aureus (29%) were the most frequent pathogens and were associated with pump pocket infections, while Staphylococcus epidermis (11%) was associated with peripheral infections. PET/CT affected the clinical management of 83% of patients with infection, resulting in surgical debridement (8%), pump exchange (13%), and upgrade in the transplant listing status (10%), leading to 8% of urgent transplants. Conclusions: 18F-FDG-PET/CT enables the diagnosis and characterization of the extent of LVAD infections, which can significantly affect the clinical management of these patients.
AB - Background: Previous retrospective studies suggest a good diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/computed tomography (CT) in left ventricular assist device (LVAD) infections. Our aim was to prospectively evaluate the role of PET/CT in the characterization and impact on clinical management of LVAD infections. Methods: A total of 40 patients (aged 58 [53-62] years) with suspected LVAD infection and 5 controls (aged 69 [64-71] years) underwent 18F-FDG-PET/CT. Four LVAD components were evaluated: exit site and subcutaneous driveline (peripheral), pump pocket, and outflow graft. The location with maximal uptake was considered the presumed site of infection. Infection was confirmed by positive culture (exit site or blood) and/or surgical findings. Results: Visual uptake was present in 40 patients (100%) in the infection group vs 4 (80%) control subjects. For each individual component, the presence of uptake was more frequent in the infection than in the control group. The location of maximal uptake was most frequently the pump pocket (48%) in the infection group and the peripheral components (75%) in the control group. Maximum standard uptake values (SUVmax) were higher in the infection than in the control group: SUVmax (average all components): 6.9 (5.1-8.5) vs 3.8 (3.7-4.3), p = 0.002; SUVmax (location of maximal uptake): 10.6 ± 4.0 vs 5.4 ± 1.9, p = 0.01. Pump pocket infections were more frequent in patients with bacteremia than without bacteremia (79% vs 31%, p = 0.011). Pseudomonas (32%) and methicillin-susceptible Staphylococcus aureus (29%) were the most frequent pathogens and were associated with pump pocket infections, while Staphylococcus epidermis (11%) was associated with peripheral infections. PET/CT affected the clinical management of 83% of patients with infection, resulting in surgical debridement (8%), pump exchange (13%), and upgrade in the transplant listing status (10%), leading to 8% of urgent transplants. Conclusions: 18F-FDG-PET/CT enables the diagnosis and characterization of the extent of LVAD infections, which can significantly affect the clinical management of these patients.
KW - 18F-fluorodeoxyglucose positron emission tomography
KW - LVAD infection
KW - PET/CT
KW - advanced heart failure
KW - device infection
UR - http://www.scopus.com/inward/record.url?scp=85181825566&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2023.11.002
DO - 10.1016/j.healun.2023.11.002
M3 - Article
C2 - 37951322
AN - SCOPUS:85181825566
SN - 1053-2498
VL - 43
SP - 529
EP - 538
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 4
ER -