Comparison of diagnostic performance of transesophageal echocardiography and positron emission tomography in patients with cardiovascular implantable electronic device infections.

Background: The modified Duke criteria and transesophageal echocardiography (TEE) are often insufficient to diagnose infective endocarditis in patients with cardiovascular implantable electronic devices (CIEDs). F-18-fluoro-2-deoxy-glucose positron emission tomography (18F-FDG PET/CT) is a promising method for detecting lead endocarditis.

Aims: The study aimed to compare diagnostic performance of 18F-FDG PET/CT and TEE in detecting lead endocarditis (LE).

Methods: We included 40 patients admitted to the hospital for CIED infection. Patients were classified as "LE-positive" and "LE-negative" according to TEE and 18F-FDG PET/CT findings. After three months of follow-up, the patients' lead cultures, tissue and blood cultures, and clinical responses after antibiotic treatment were reviewed using the Duke criteria. The final exact diagnosis was compared with 18F-FDG PET/CT and TEE findings.

Results: No involvement was observed on 18F-FDG PET/CT in 12 patients (30%). The remaining 25% of patients had device pocket involvement, and two patients had systemic involvement. In the follow-up of 23 patients diagnosed with LE by TEE, 14 were consistent with LE. Seventeen of 18 patients with suspicion of LE were diagnosed with definite LE by 18F-FDG PET/CT. Six of the 22 patients with negative 18F-FDG PET/CT scans were false negative and diagnosed as definite infective endocarditis. 18F-FDG PET/CT had sensitivity of 73.9% and specificity of 94.1%. It was observed that there was a statistically significant difference between TEE and PET (P = 0.006).

Conclusion: 18F-FDG PET/CT is superior to TEE in diagnosing IE in patients with CIED.