Guidelines in review: Comparison of ESC and AHA guidance for the diagnosis and management of infective endocarditis in adults

Journal of Nuclear Cardiology, Jun 2018

Over recent years, new evidence has led a rethinking of the available guidance on the diagnosis and management of infective endocarditis (IE). This review compares the most recently available guidance provided by the American Heart Association (AHA) IE Writing Committee, and the Task Force for the management of IE of the European Society of Cardiology (ESC). This represents the sixth of a new series of comparative guidelines review published in the Journal.

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Guidelines in review: Comparison of ESC and AHA guidance for the diagnosis and management of infective endocarditis in adults

Received May Guidelines in review: Comparison of ESC and AHA guidance for the diagnosis and management of infective endocarditis in adults David J. Murphy 0 4 Munaib Din 0 4 Fadi G. Hage 0 FASNC 0 2 3 Eliana Reyes 0 0 Reprint requests: Eliana Reyes , MD, PhD, FESC , Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust , Sydney Street, London, SW3 6NP , UK 1 Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust , London , UK 2 Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham , Birmingham, AL , USA 3 Section of Cardiology, Birmingham Veteran Affairs Medical Center , Birmingham, AL , USA 4 King's College London and Guy's and St Thomas' NHS Foundation Trust PET Centre , London , UK Over recent years, new evidence has led a rethinking of the available guidance on the diagnosis and management of infective endocarditis (IE). This review compares the most recently available guidance provided by the American Heart Association (AHA) IE Writing Committee, and the Task Force for the management of IE of the European Society of Cardiology (ESC). This represents the sixth of a new series of comparative guidelines review published in the Journal. (J Nucl Cardiol 2018) - Abbreviations CTCA CDRIE DSA 18FFDG IE LOE Computed tomographic angiography Cardiac device-related endocarditis Digital subtraction angiography 18-fluorodeoxyglucose coronary infective Infective endocarditis Level of evidence Over recent years, new evidence has led to a rethink of the available guidance on the diagnosis and management of infective endocarditis (IE). This review compares the most recently available recommendations provided by the American Heart Association (AHA) IE Writing Committee, and the Task Force for the man agement of IE of the European Society of Cardiology (ESC).1,2 Class (I, II or III) and level of evidence (A, B or C) are provided for each recommendation where given by the guidelines (Tables 1, 2, 3; Figures 1, 2). As in previous comparative guidelines reviews published in the Journal,3–7 this review focuses on the role of imaging in the evaluation and management of patients with suspected IE. *According to the AHA scientific statement, TEE is preferred over TTE, but the latter should be performed if TEE is not immediately available. TTE may be sufficient in small children AHA statement also suggests TEE as first-line test in patients with a prosthetic valve and suspected IE In this clinical scenario, the AHA statement recommends repeating the TEE in 3 to 5 days or sooner §ESC guidelines stipulate that the timing and mode (TTE or TEE) of repeat test depend on initial findings, microorganism type, and initial response to therapy TEE is recommended in pa ents with suspected CDRIE with posi ve or nega ve blood cultures, independent of TTE results, to evaluate lead-related IE and heart valve infec on Intracardiac echocardiography may be considered in pa ents with suspected CDRIE, posi ve blood cultures and nega ve TTE and TEE results. Radiolabelled leucocyte scin graphy and 18F-FDG PET/CT imaging may be considered addi onal tools in pa ents with suspected CDRIE, posi ve blood cultures and nega ve echocardiography Class LOE Class LOE I IIb IIb ESC C C C AHA NSER NSER NSER CT Cardiac CT may be used in cases in which defini ve evidence of IE and its complica ons is not secured with TEE CTCA can be used as an alterna ve to invasive coronary angiography in pa ents with IE Cardiac CT can be used to detect abscesses/pseudoaneurysms in na ve valve IE, and to assess the extent of any perivalvular complica on CT may help surgical planning in aor c IE CT can be used to iden fy pulmonary abscesses and infarcts in rightsided IE Cerebral CTA is reasonable as an initial imaging test for the detec on of intracranial myco c aneurysms Cerebrovascular imaging (in general) may be considered in all pa ents with le -sided IE who have no CNS signs or symptoms Cerebral CTA may be used instead of MRA to diagnose cerebral myco c aneurysms in cri cally ill pa ents CT/CTA can be used to detect splenic and other systemic abscesses, as well as IE-related peripheral vascular complica ons† MRI Cerebral MRA may be considered as first line for the detec on of cerebral myco c aneurysms Cerebral MRI may be considered for be er lesion characterisa on in IE pa ents with neurological symptoms Angiography Digital subtrac on angiography (DSA) is reasonable as an ini al diagnos c test in pa ents with suspected cerebral myco c aneurysms Conven onal angiography may be considered for the detec on of intracranial myco c aneurysms in pa ents with nega ve CTA, MRA or DSA Radionuclide Imaging 18F-FDG PET/CT and radiolabelled leucocyte scin graphy may help reduce the number of misdiagnosed IE classified in the “possible IE” category of the Duke criteria 18F-FDG PET/CT or radiolabelled leucocyte scin graphy may help visualize peripheral emboli and metasta c infec ous events 18F-FDG PET/CT must be interpreted with cau on in pa ents who have undergone cardiac surgery within 3 months, as false posi ves may occur due to post-opera ve inflamma on IIa IIa IIa NSER Y* NSER‡ Y* NSER Y* Y* Y* Y* Y* Y* Y* B B B IIa IIb I IIa IIa IIa Y* Y* Y* Y* Y§ B C B B B B Established and proposed indica ons for advanced imaging in IE *These proposed indications are discussed in the guidelines but neither the ESC guidelines nor the AHA scientific statement give specific or formal recommendation The AHA statement recommends that, in IE patients with suspected metastatic foci of infection, the choice of diagnostic technique (ultrasonography, CT or MRI) should be individualised for each patient (Class I; LOE, C) Although there is no specific recommendation, the ESC guidelines state that patients with suspected splenic complications should be evaluated by CT, MRI or ultrasound §The AHA statement recognises that more studies are needed to determine the role of 18F-FDG PET/CT imaging in the diagnosis and management of patients with IE, and highlights evidence on the usefulness of this technique for the detection of peripheral emboli and other extracardiac complications Disclosure All authors have nothing to disclose. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 1. Baddour LM , Wilson WR , Bayer AS , Fowler VG Jr, Tleyjeh IM , Rybak MJ , et al. 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. Infective Endocarditis in Adults: Diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association . Circulation 2015 ; 132 : 1435 - 86 . 2. Habib G , Lancellotti P , Antunes MJ , Bongiorni MG , Casalta JP , Del Zotti F , et al. ESC Scientific Document Group. 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) . Eur Heart J 2015 ; 36 : 3075 - 128 . 3. Velasco A , Reyes E , Hage FG . Guidelines in review: Comparison of the 2014 ACC/AHA guidelines on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery and the 2014 ESC/ESA guidelines on noncardiac surgery: Cardiovascular assessment and management . J Nucl Cardiol 2017 ; 24 : 165 - 70 . 4. Stirrup J , Velasco A , Hage FG , Reyes E . Comparison of ESC and ACC/AHA guidelines for myocardial revascularization . J Nucl Cardiol 2017 ; 24 : 1046 - 53 . 5. Velasco A , Stirrup J , Reyes E , Hage FG . Guidelines in review: Comparison between AHA/ACC and ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death . J Nucl Cardiol 2017 ; 24 : 1902 - 3 . 6. Prejean SP , Din M , Reyes E , Hage FG . Guidelines in review: Comparison of the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation . J Nucl Cardiol 2017 . https://doi.org/10.1007/s12350-017- 1137-z. 7. Joseph J , Velasco A , Hage FG , Reyes E. Guidelines in review: Comparison of ESC and ACC/AHA guidelines for the diagnosis and management of patients with stable coronary artery disease . J Ncl Cardiol 2018 ; 25 : 509 - 15 .


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David J. Murphy, Munaib Din, Fadi G. Hage, Eliana Reyes. Guidelines in review: Comparison of ESC and AHA guidance for the diagnosis and management of infective endocarditis in adults, Journal of Nuclear Cardiology, 2018, 1-6, DOI: 10.1007/s12350-018-1333-5