RT Book, Section
A1 Chen, Wengen
A1 Dilsizian, Vasken
A2 Heller, Gary V.
A2 Bateman, Timothy M.
A2 Case, James A.
A2 Arumugam, Parthiban
SR Print(0)
ID 1159185390
T1 FDG PET/CT for Imaging Cardiovascular Device Infection
T2 Cardiovascular PET: Current Concepts
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259860485
LK accesscardiology.mhmedical.com/content.aspx?aid=1159185390
RD 2024/04/19
AB There  has  been  a  worldwide  increase  in  implantation  of  cardiovascular  devices,  including  cardiac  implantable  electronic  devices  (CIED),  valve  prostheses,  left  ventricular  assist  devices  (LVAD),  and  vascular  grafts.  CIEDs,  including  pacemakers  and  implantable  cardioverter  defibrillators  (ICDs)  are  the  major  devices  installed.  Almost  one-half  of  the  world's  cardiac  device  installation  is  performed  in  the  United  States.1  Infection  is  a  major  complication  after  device  installation,  and,  unfortunately,  the  increasing  number  of  cardiac  device  procedures  is  exceeded  by  an  even  higher  rate  of  increasing  cases  of  device  infection,  mainly  because  of  older  age  of  the  new  device  recipients  with  longer  hospital  stays  and  multiple  comorbidities.2,3  Approximately  20%-30%  of  patients  with  CIED  require  device  extraction  and  reinstallation,  mainly  due  to  infection,4  which  is  a  major  societal  and  medical  burden.  Infection  of  a  foreign  body  device  is  also  associated  with  a  high  risk  of  mortality.  It  has  been  reported  that  12-week  all-cause  mortality  was  35%  in  patients  with  a  confirmed  cardiac  device  infection,  especially  for  those  with  methicillin-resistant  S.  aureus  infection.5  One-year  mortality  was  reported  as  high  as  17%  in  endovascular  infection  patients  even  after  device  removal.6  Thus,  early  and  accurate  diagnosis  of  cardiac  device  infection  is  critical  for  prompt  clinical  decision  making,  such  as  intravenous  antibiotics  alone  or  device  removal  in  a  timely  manner  before  significant  damage  occurs.  Diagnosis  of  cardiac  device  infection  remains  a  challenge  for  current  diagnostic  radiology  tools.  For  example,  CT  or  MRI  suffers  from  metal  artifacts  and  findings  are  nonspecific  for  infection.  Transthoracic  echocardiography  (TTE)  or  transesophageal  echocardiography  (TEE)  is  limited  to  identification  of  intracardiac  infection,  and  not  useful  for  extracardiac  source  of  infection.  Although  radiolabeled  autologous  white  blood  cell  (WBC)  scintigraphy  has  been  used  for  infection  evaluation,  its  sensitivity  for  device  infection  is  variable.7,8  Thus,  a  scan  with  high  sensitivity  and  accuracy  is  needed  to  facilitate  the  prompt  and  accurate  diagnosis  of  cardiac  device  infection.