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European Journal of Nuclear Medicine and Molecular Imaging

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01-01-2019 | Original Article

Contribution of PET imaging to mortality risk stratification in candidates to lead extraction for pacemaker or defibrillator infection: a prospective single center study

Authors: Igor Diemberger, Rachele Bonfiglioli, Cristian Martignani, Maddalena Graziosi, Mauro Biffi, Stefano Lorenzetti, Matteo Ziacchi, Cristina Nanni, Stefano Fanti, Giuseppe Boriani

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 1/2019

Abstract

Purpose

¹⁸F-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 ¹⁸F-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. ¹⁸F-FDG PET/CT was performed in all patients prior TLE.

Results

There were 105 consecutive patients with confirmed CIEDI enrolled. An increased ¹⁸F-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 (22.5 ± 14.0 days vs. 8.6 ± 13.0 days; p = 0.005). Implementation of ¹⁸F-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 ¹⁸F-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 ¹⁸F-FDG PET/CT data, absence of overt/hidden pocket involvement in CIEDI and a (glomerular filtration rate) GFR < 60 ml/min were the only independent predictors of mortality at long term.

Conclusions

Patient with CIEDI and a Cold Closed Pocket (i.e., a CIED pocket without skin erosion/perforation nor increased capitation at ¹⁸F-FDG PET/CT) present worse long-term survival. Patient management can benefit by systematic adoption of pre-TLE ¹⁸F-FDG PET/CT through improved identification of CIED related endocarditis (CIEDIE) and hidden involvement of CIED pocket.

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Title: Contribution of PET imaging to mortality risk stratification in candidates to lead extraction for pacemaker or defibrillator infection: a prospective single center study
Authors: Igor Diemberger
Rachele Bonfiglioli
Cristian Martignani
Maddalena Graziosi
Mauro Biffi
Stefano Lorenzetti
Matteo Ziacchi
Cristina Nanni
Stefano Fanti
Giuseppe Boriani
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 1/2019
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4142-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Contribution of PET imaging to mortality risk stratification in candidates to lead extraction for pacemaker or defibrillator infection: a prospective single center study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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