Molecular Imaging of Valvular Diseases and Cardiac Device Infection

Area of Science:

• Cardiovascular Imaging
• Nuclear Medicine
• Infectious Diseases

Background:

• Positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose is increasingly used for diagnosing prosthetic valve endocarditis and cardiac device infections.
• Current guideline recommendations are largely based on expert opinion due to a lack of prospective randomized trials.
• 18F-sodium fluoride PET shows promise for measuring aortic valve microcalcification, a marker of inflammation, but carries risks in research settings.

Approach:

• This review examines the current role and potential of molecular imaging techniques in managing cardiac valvular diseases and device infections.
• Focuses on the application of 18F-fluorodeoxyglucose PET for prosthetic valve endocarditis and implantable electronic device/left ventricular assist device infections.
• Discusses 18F-sodium fluoride PET in the context of aortic stenosis and bioprosthetic valve degeneration.

Key Points:

• 18F-fluorodeoxyglucose PET is a valuable tool for diagnosing complex cardiac conditions like prosthetic valve endocarditis and device infections.
• The clinical utility of 18F-fluorodeoxyglucose PET is supported by growing evidence, though robust clinical trials are still needed.
• 18F-sodium fluoride PET offers a novel approach to assess valvular inflammation and calcification, relevant to aortic stenosis and prosthetic valve performance.

Conclusions:

• Molecular imaging, particularly PET, is becoming essential in the diagnostic workup of cardiac valvular diseases and device-related infections.
• Further prospective studies are crucial to solidify guideline recommendations for PET imaging in these clinical scenarios.
• The reviewed molecular imaging techniques hold significant potential for improving patient outcomes in cardiology and cardiac surgery.