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FDG PET/CT for Detecting LVAD Infection
Study Questions:
What is the feasibility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis of left ventricular assist device (LVAD) infection?
Methods:
The investigators performed FDG PET/CT in 35 heart failure patients with an LVAD; 24 with and 11 without clinical suspicion of infection. Microbiology and/or clinical follow-up were used as the final diagnosis standard. Survival rates were compared in patients with and without FDG evidence of infection, and in relation to peripheral (exit wound site or driveline) versus central (cannula or pump) device infection.
Results:
Of 35 patients, 28 (80%) showed metabolic evidence of LVAD infection: 5 limited to the periphery and 23 with extension to the central components of the device. The remaining 7 patients showed no metabolic evidence of infection, which was confirmed by microbiology and clinical follow-up. When CT images were interpreted independently from the FDG PET and clinical information, only 4 of 35 (11%) suggested the possibility of infection. Deaths occurred in 14 of 28 (50%) infected patients during a mean of 23 months of follow-up after the diagnosis by FDG PET/CT: 12 (86%) with central infection and only 2 with peripheral infection. By contrast, none of the 7 (0%) noninfected patients died (p = 0.03).
Conclusions:
The authors concluded that FDG PET/CT is a useful technique for identifying LVAD infection and determining the site and pattern of the infection.
Perspective:
This study reports that FDG PET/CT imaging differentiates LVAD infected from noninfected patients and further localizes the site of the infection as peripheral (percutaneous exit site and/or drive line) versus central (cannula exterior and/or pump pocket). These data and early detection of LVAD infection have important clinical, therapeutic, and prognostic implications. Given the poor prognosis of LVAD infection if not detected and treated early, especially before extending to the central components of the LVAD, FDG PET/CT may guide medical and surgical management of LVAD-infected patients and potentially improve patient outcomes. Additional prospective studies are indicated to validate these findings.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support, Interventions and Imaging, Computed Tomography, Nuclear Imaging
Keywords: Cardiac Surgical Procedures, Diagnostic Imaging, Fluorodeoxyglucose F18, Heart-Assist Devices, Heart Failure, Infections, Positron-Emission Tomography, Radiation Protection, Secondary Prevention, Tomography, X-Ray Computed
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