Multimodality imaging in marantic endocarditis associated with cancer: a multicentric cohort study
Résumé
Aims We aimed to assess the role of multimodality imaging (MMI) in the diagnosis of marantic endocarditis (ME) associated with cancers and to describe clinical characteristics, management, and outcome of these patients. Methods and results In a retrospective multicentric study including four tertiary centers for treatment of endocarditis in France and Belgium, patients with a diagnosis of ME were included. Demographic, MMI (echocardiography, computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F -FDG PET/CT) and management data were collected. Long-term mortality was analyzed. Between November 2011 and August 2021, 47 patients with a diagnosis of ME were included. Mean age was 65 +/- 11 years. ME occurred in 43 cases (91%) on native valves. Vegetations were detected by echocardiography in all cases and in 12 cases (26%) by CT. No patient had an increased cardiac 18F -FDG valve uptake. The most common cardiac valve involved was aortic (34 cases, 73%). 22 patients (46%) had a known cancer before ME and 25 cases (54%) were diagnosed thanks to multimodality imaging. 18-FDG PET/CT was performed in 30 patients (64%) and allowed a new diagnosis of cancer in 14 patients (30%). Systemic embolism was frequent (40 patients, 85% of cases). 41 patients (87%) were treated medically with anticoagulation therapy. One year mortality was 55% (26 patients). Conclusions ME remains associated with high risk of complications and death.