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In this multicenter study, 160 patients with a prosthetic heart valve (median age, 62 years [43-73]; 68% male; 82 mechanical valves; 62 biological; 9 transcatheter aortic valve replacements; 7 other) who underwent FDG PET/CT for suspicion of PVE, and 77 patients with a PV (median age, 73 years [65-77]; 71% male; 26 mechanical valves; 45 biological; 6 transcatheter aortic valve replacements) who underwent FDG PET/CT for other indications (negative control group), were retrospectively included. Their scans were reassessed by 2 independent observers blinded to all clinical data, both visually and quantitatively on available European Association of Nuclear Medicine Research Ltd-standardized reconstructions. Confounders were identified by use of a logistic regression model and subsequently excluded.Visual assessment of FDG PET/CT had a sensitivity/specificity/positive predictive value/negative predictive value for PVE of 74%/91%/89%/78%, respectively. Low inflammatory activity (C-reactive protein40 mg/L) at the time of imaging and use of surgical adhesives during prosthetic heart valve implantation were significant confounders, whereas recent valve implantation was not. After the exclusion of patients with significant confounders, diagnostic performance values of the visual assessment increased to 91%/95%/95%/91%. As a semiquantitative measure of FDG uptake, a European Association of Nuclear Medicine Research Ltd-standardized uptake value ratio of ≥2.0 was a 100% sensitive and 91% specific predictor of PVE.Both visual and quantitative assessments of FDG PET/CT have a high diagnostic accuracy in patients in whom PVE is suspected. FDG PET/CT should be implemented early in the diagnostic workup to prevent the negative confounding effects of low inflammatory activity (eg, attributable to prolonged antibiotic therapy). Recent valve implantation was not a significant predictor of false-positive interpretations, but surgical adhesives used during implantation were.

Introduction: Obesity is a risk factor for atrial fibrillation (AF), and reduction of weight has been shown to reduce the burden of AF. However, the exact underlying pathogenesis is unknown. Hypothesis: We hypothesize that obesity is related with impaired left atrial function, measured with echocardiographic strain analysis, in young patients ( Methods: We studied 94 patients of the Phenotyping young-onset AF patients study, all with sinus rhythm during echocardiography. Detailed clinical and echocardiographic information was collected. Three strain-patterns (reservoir, activation, and conduit strain) representing left atrial functional phases were measured. Results: Of the 94 patients, 32 were obese and 62 were non-obese (34±3 kg/m2 vs. 25±2 kg/m2, p Conclusions: In young patients with recent onset AF, obesity is associated with impaired left atrial function, in absence of dilatation. Left atrial dysfunction may be the first sign of atrial remodeling in obese AF patients.