145: Role of radiolabeled leukocyte scintigraphy in management of patients with a suspicion of prosthetic valve endocarditis

Abstract

In patients with a suspicion of prosthetic valve endocarditis (PVE), detection of perivalvular infection can be difficult based only on echocardiography, but has an important impact in guiding surgical indications. The aim of this retrospective study was to test the interest of leukocyte scintigraphy (LS) for detection of perivalvular infection in patients with suspicion of non-complicated PVE. LS was performed in 42 patients admitted for suspicion of PVE. Results of LS were classified as positive, with either intense or mild accumulation of radiolabeled leukocytes in the cardiac area, or negative. Macroscopical aspects and bacteriology were obtained from patients who underwent cardiac surgery (n=10). Clinical outcome was collected in patients treated medically (n=32). Among patients with an intense signal with LS who underwent surgery (n=6), 5 had an abscess confirmed during intervention, and 1, post-operatively. Patients with an intense accumulation of radiolabeled leukocytes with scintigraphy and treated medically (n=3) had a poor outcome: death (n=1); prosthetic valve dehiscence (n=1); recurrent endocarditis (n=1). Among patients with a mild activity with LS (n=5), one patient developed a large prosthetic valve dehiscence during follow-up. The 4 remaining patients were treated medically and did not present any recurrent endocarditis after a median follow-up of 14 months. No abscess was detected in patients with negative LS who underwent surgery (n=4). Among patients with negative LS treated medically (n=24), none presented recurrent endocarditis after a mean follow-up of 15±16 months. In total, LS helped to identify perivalvular infection or abscesses in 12 out of 42 patients (29%). This retrospective study suggests that LS is useful for identification of perivalvular infection and could help in guiding surgical indications in patients with suspicion of PVE.