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Its use in the diagnosis of infectious endocarditis (IE) is mentioned among the many applications referred to by the authors. With regard to this issue, we concur with its usefulness in cardiology and would like to communicate our experience in the diagnosis of infectious endocarditis using PET.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">IE is a very heterogeneous disease with an incidence of three to seven cases per 100,000<span class="elsevierStyleHsp" style=""></span>people/year,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> increasing in recent years because of the higher prevalence of valvular prosthesis carriers, the rise of percutaneous prostheses in elderly patients and a greater indication of intracardiac devices. The entity has a high mortality rate of approximately 30%, which has not decreased despite advances in both early diagnosis and treatment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Furthermore, its diagnosis continues to be a challenge. In this sense, the latest 2015 European Society of Cardiology guidelines includes PET as a diagnostic tool for the first time, to be used within the modified Duke criteria.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For this reason, we have recently reviewed all PET requests in recent years for <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose in our centre because of suspected endocarditis. The aforementioned changes to the diagnostic criteria and their inclusion as a Duke criterion have led to an exponential increase in the number of requests, from only five in 2015 to 18 in 2017. A total of 35 patients were studied, with an average age of 73, 72% were carriers of valvular prostheses and 37% of intracardiac devices. Of the total PET requests, the reason for the request in 26 patients was clinical suspicion and an initial diagnosis, according to Duke criteria, of a possible EI, but with neither definitive echocardiographic images nor doubtful images. In the other nine patients, the diagnosis of IE had been confirmed by echocardiography and PET was requested to complete the assessment. In patients with clinical suspicion, but without echocardiographic diagnosis (26), PET was the definitive test that served to confirm or rule out IE. Of these 26 patients, in 13 (50%) PET showed pathological uptake, a finding that, together with the patient's clinical context, facilitated the final, definitive diagnosis of IE. In the remaining 13 the test was negative, so EI was ruled out (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In our series, with a high prevalence of valvular prostheses and devices, PET facilitated a diagnosis of IE and as a result there was a change in the patient's therapeutic management, as well as surgical indication for patients who had not been previously given it. Thus, PET is a very useful test for early diagnosis in patients with valvular prostheses and intracardiac devices, when the echocardiographic image loses sensitivity and specificity.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The latest guides affirm that diagnosis involves an initial transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE), and if the suspicion persists, in this group of patients, PET/CT is recommended as the second line. In addition, PET confers added value due to its ability to detect peripheral embolic phenomena, increasing the diagnostic yield of this test. Another advantage of combining metabolic and anatomical images, is that a lot of information can be obtained regarding perivalvular complications (abscesses or fistulas), thus facilitating patient management and sometimes even a change of attitude. On the basis of all the above, and due to its high diagnostic yield, we are witnessing both an increase in the use of this test and in its generalisation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Álvarez Velasco R, Salvat Dávila C, Vigil Díaz C. Utilidad de la tomografía por emisión de positrones en el diagnóstico de la endocarditis infecciosa. Med Clin (Barc). 2019;152:e43–e44.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1322 "Ancho" => 2167 "Tamanyo" => 185312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of the patients reviewed, the tests performed and their results.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "e31–4" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplicaciones no oncológicas de la PET/TC" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.F. Jiménez-Bonilla" 1 => "I. Banzo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2017.10.026" "Revista" => array:3 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" "volumen" => "150" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council" "etal" => true "autores" => array:6 [ 0 => "L.M. Baddour" 1 => "W.R. Wilson" 2 => "A.S. Bayer" 3 => "V.G. Fowler Jr." 4 => "I.M. Tleyjeh" 5 => "M.J. Rybak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0000000000000296" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "132" "paginaInicial" => "1435" "paginaFinal" => "1486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26373316" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Challenges in infective endocarditis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.J. Cahill" 1 => "L.M. Baddour" 2 => "G. Habib" 3 => "B. Hoen" 4 => "E. Salaun" 5 => "G.B. Pettersson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2017" "volumen" => "3" "paginaInicial" => "325" "paginaFinal" => "344" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ESC Scientific Document Group" "etal" => true "autores" => array:6 [ 0 => "G. Habib" 1 => "P. Lancellotti" 2 => "M.J. Antunes" 3 => "M.G. Bongiorni" 4 => "J.P. Casalta" 5 => "F. del Zotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv319" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2015" "volumen" => "36" "paginaInicial" => "3075" "paginaFinal" => "3128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26320109" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015200000008/v1_201904100623/S2387020619300944/v1_201904100623/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015200000008/v1_201904100623/S2387020619300944/v1_201904100623/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619300944?idApp=UINPBA00004N" ]
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Vol. 152. Issue 8.
Pages e43-e44 (April 2019)
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Vol. 152. Issue 8.
Pages e43-e44 (April 2019)
Letter to the Editor
Usefulness of PET scan in the diagnosis of infective endocarditis
Utilidad de la tomografía por emisión de positrones en el diagnóstico de la endocarditis infecciosa
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