Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 1, January, p. 113–119

doi: 10.17219/acem/92315

Publication type: original article

Language: English

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The usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing lead-dependent infective endocarditis

Barbara A. Małecka1,2,A,B,D,F, Andrzej Ząbek1,B,C,E,F, Maciej Dębski1,B,E,F, Wojciech Szot3,4,B,E,F, Katarzyna Holcman5,B,E,F, Krzysztof Boczar1,B,E,F, Mateusz Ulman1,B,E,F, Jacek Lelakowski1,2,B,E,F, Magdalena Kostkiewicz2,5,B,E,F

1 Department of Electrocardiology, John Paul II Hospital, Kraków, Poland

2 Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland

3 Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland

4 Nuclear Medicine Department, John Paul II Hospital, Kraków, Poland

5 Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland

Abstract

Background. Lead-dependent infective endocarditis (LDIE) is a life-threatening complication of permanent transvenous cardiac pacing. According to the 2015 European Society of Cardiology (ECS) guidelines, the diagnosis of LDIE is based on the modified Duke criteria (MDC), while single-photon emission computed tomography with conventional computed tomography (SPECT-CT) with radioisotope-labeled leukocytes serves as an additional tool in difficult cases. The major challenge is to differentiate between true vegetation and a thrombus.
Objectives. The aim of the study was to evaluate the usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing LDIE in patients with intracardiac masses (ICMs).
Material and Methods. The prospective registry included 40 consecutive patients admitted with an ICM on the lead and suspicion of LDIE. The confirmation or rejection of the LDIE diagnosis was made according to an algorithm based on the MDC. The cohort was divided into 2 groups: patients with definite and possible LDIE diagnoses based on the MDC (the LDIE-positive group), and patients with negative LDIE diagnoses according to the MDC (the LDIE-negative group). All patients underwent SPECT-CT with radioisotope-labeled leukocytes. The diagnostic ability of SPECT-CT was compared to the gold standard MDC.
Results. The LDIE-positive group with diagnosis based on the MDC consisted of 19 patients (LDIE definite – 11; LDIE possible – 8). The LDIE diagnosis was rejected on the basis of the MDC in 21 patients. The SPECT-CT results were compared with the MDC results and showed 73.7% sensitivity, 81.0% specificity, 77.5% accuracy, 77.8% positive predictive value (PPV), 77.3% negative predictive value (NPV), likelihood ratio positive (LR+) 3.868, likelihood ratio negative (LR–) 0.325, and moderate agreement (κ = 0.548, p < 0.001). After the exclusion of 5 patients treated with antibiotics at the time of the SPECT-CT, LR+ and LRimproved to 5.250 and 0, respectively, and inter-test agreement amounted to almost perfect concordance (κ = 0.773, p < 0.001).
Conclusion. Single-photon emission computed tomography with conventional CT with radioisotopelabeled leukocytes is a useful, efficient, single-step test for diagnosing LDIE.

Key words

scintigraphy, vegetation, infective endocarditis, cardiac pacing, artificial, radionuclide imaging

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