Jan M Sommerlath Sohns1, Hannah Kröhn1, Alexandra Schöde2, Thorsten Derlin1, Axel Haverich2, Jan D Schmitto2, Frank M Bengel3. 1. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany; and. 2. Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany. 3. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany; and bengel.frank@mh-hannover.de.
Abstract
Accurate definition of the extent and severity of left-ventricular assist device (LVAD) infection may facilitate therapeutic decision making and targeted surgical intervention. Here, we explore the value of 18F-FDG PET/CT for guidance of patient management. Methods: Fifty-seven LVAD-carrying patients received 85 whole-body 18F-FDG PET/CT scans for the work-up of device infection. Clinical follow-up was obtained for up to 2 y. Results: PET/CT showed various patterns of infectious involvement of the 4 LVAD components: driveline entry point (77% of patients), subcutaneous driveline path (87%), pump pocket (49%), and outflow tract (58%). Driveline smears revealed Staphylococcus or Pseudomonas strains as the underlying pathogen in most cases (48 and 34%, respectively). At receiver-operating-characteristic analysis, an 18F-FDG SUV of more than 2.5 was most accurate to identify smear-positive driveline infection. Infection of 3 or all 4 LVAD components showed a trend toward lower survival than did infection of 2 or fewer components (P = 0.089), whereas involvement of thoracic lymph nodes was significantly associated with an adverse outcome (P = 0.001 for nodal SUV above vs. below median). Finally, patients who underwent early surgical revision within 3 mo after PET/CT (n = 21) required significantly less inpatient hospital care during follow-up than did those receiving delayed surgical revision (n = 11; P < 0.05). Conclusion: Whole-body 18F-FDG PET/CT identifies the extent of LVAD infection and predicts adverse outcome. Initial experience suggests that early image-guided surgical intervention may facilitate a less complicated subsequent course.
Accurate definition of the extent and severity of left-ventricular assist device (LVAD) infection may facilitate therapeutic decision making and targeted surgical intervention. Here, we explore the value of 18F-FDG PET/CT for guidance of patient management. Methods: Fifty-seven LVAD-carrying patients received 85 whole-body 18F-FDG PET/CT scans for the work-up of device infection. Clinical follow-up was obtained for up to 2 y. Results: PET/CT showed various patterns of infectious involvement of the 4 LVAD components: driveline entry point (77% of patients), subcutaneous driveline path (87%), pump pocket (49%), and outflow tract (58%). Driveline smears revealed Staphylococcus or Pseudomonas strains as the underlying pathogen in most cases (48 and 34%, respectively). At receiver-operating-characteristic analysis, an 18F-FDG SUV of more than 2.5 was most accurate to identify smear-positive driveline infection. Infection of 3 or all 4 LVAD components showed a trend toward lower survival than did infection of 2 or fewer components (P = 0.089), whereas involvement of thoracic lymph nodes was significantly associated with an adverse outcome (P = 0.001 for nodal SUV above vs. below median). Finally, patients who underwent early surgical revision within 3 mo after PET/CT (n = 21) required significantly less inpatient hospital care during follow-up than did those receiving delayed surgical revision (n = 11; P < 0.05). Conclusion: Whole-body 18F-FDG PET/CT identifies the extent of LVAD infection and predicts adverse outcome. Initial experience suggests that early image-guided surgical intervention may facilitate a less complicated subsequent course.
Authors: Margaret M Hannan; Shahid Husain; Frauke Mattner; Lara Danziger-Isakov; Richard J Drew; G Ralph Corey; Stephan Schueler; William L Holman; Leo P Lawler; Steve M Gordon; Niall G Mahon; John M Herre; Kate Gould; Jose G Montoya; Robert F Padera; Robert L Kormos; John V Conte; Martha L Mooney Journal: J Heart Lung Transplant Date: 2011-04 Impact factor: 10.247
Authors: Jan D Schmitto; Jasmin S Hanke; Sebastian V Rojas; Murat Avsar; Axel Haverich Journal: J Heart Lung Transplant Date: 2015-03-07 Impact factor: 10.247
Authors: Karen A Hicks; Kenneth W Mahaffey; Roxana Mehran; Steven E Nissen; Stephen D Wiviott; Billy Dunn; Scott D Solomon; John R Marler; John R Teerlink; Andrew Farb; David A Morrow; Shari L Targum; Cathy A Sila; Mary T Thanh Hai; Michael R Jaff; Hylton V Joffe; Donald E Cutlip; Akshay S Desai; Eldrin F Lewis; C Michael Gibson; Martin J Landray; A Michael Lincoff; Christopher J White; Steven S Brooks; Kenneth Rosenfield; Michael J Domanski; Alexandra J Lansky; John J V McMurray; James E Tcheng; Steven R Steinhubl; Paul Burton; Laura Mauri; Christopher M O'Connor; Marc A Pfeffer; H M James Hung; Norman L Stockbridge; Bernard R Chaitman; Robert J Temple Journal: J Am Coll Cardiol Date: 2018-03-06 Impact factor: 24.094
Authors: Daniel J Goldstein; David Naftel; William Holman; Lavanya Bellumkonda; Salpy V Pamboukian; Francis D Pagani; James Kirklin Journal: J Heart Lung Transplant Date: 2012-07-04 Impact factor: 10.247
Authors: Piotr Ponikowski; Adriaan A Voors; Stefan D Anker; Héctor Bueno; John G F Cleland; Andrew J S Coats; Volkmar Falk; José Ramón González-Juanatey; Veli-Pekka Harjola; Ewa A Jankowska; Mariell Jessup; Cecilia Linde; Petros Nihoyannopoulos; John T Parissis; Burkert Pieske; Jillian P Riley; Giuseppe M C Rosano; Luis M Ruilope; Frank Ruschitzka; Frans H Rutten; Peter van der Meer Journal: Eur Heart J Date: 2016-05-20 Impact factor: 29.983
Authors: Rudolf A Werner; James T Thackeray; Johanna Diekmann; Desiree Weiberg; Johann Bauersachs; Frank M Bengel Journal: J Nucl Med Date: 2020-04-17 Impact factor: 11.082
Authors: D Ten Hove; G Treglia; R H J A Slart; K Damman; M Wouthuyzen-Bakker; D F Postma; O Gheysens; R J H Borra; G Mecozzi; P P van Geel; B Sinha; A W J M Glaudemans Journal: Eur J Nucl Med Mol Imaging Date: 2020-06-27 Impact factor: 9.236