[Comparison between definite endocarditis and possible endocarditis according to the Duke Criteria, in a monocentric
P Abassade1, C Ganter, P-Y Baudouy
1Service de Cardiologie, Groupe Hospitalier Paris-Saint-Joseph, Paris, France. pabassade@hotmail.fr
Insights
Possible endocarditis (PE) patients were older and more frequently lacked echocardiographic signs compared to definite endocarditis (DE) patients. Both groups shared similar fever, cardiac failure, and microbiological profiles, highlighting key differences in diagnosis.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Infective endocarditis (IE) diagnosis relies on clinical, microbiological, and echocardiographic findings.
- The Duke criteria categorize IE into definite (DE) and possible (PE) based on these findings.
- Understanding differences between DE and PE can refine diagnostic and treatment strategies.
Purpose of the Study:
- To compare patients with definite endocarditis (DE) and possible endocarditis (PE) based on the Duke criteria.
- To identify distinct clinical and diagnostic characteristics between DE and PE groups in a monocentric cohort.
Main Methods:
- A retrospective analysis of 45 endocarditis cases (29 DE, 16 PE) was conducted.
- Data collected included patient demographics, comorbidities, clinical signs, echocardiographic findings, and microbiological results.
- Statistical comparisons were performed between the DE and PE groups.
Main Results:
- The PE group was significantly older (74 years) than the DE group (66 years).
- Echocardiographic signs of endocarditis were less frequent in the PE group (13% vs. 97% with signs).
- Fever, cardiac failure, pre-existing cardiopathy, positive blood cultures, and common bacterial species (Streptococcus, Enterococcus) were similar in both groups.
Conclusions:
- Patients with PE often present as older individuals with pre-existing valvulopathy and sepsis without clear echocardiographic evidence.
- Despite differences in age and echocardiographic findings, clinical and microbiological similarities exist between DE and PE.
- These findings underscore the importance of integrating all diagnostic criteria for accurate endocarditis classification.
Aim Of The Study:
To compare definite endocarditis (DE) and possible endocarditis (PE) according to the Duke criteria, in a monocentric cohort of 45 patients.
Method:
From the registers of the Cardiology Department and medical database of the hospital informatic department, 45 cases of endocarditis are colliged, 29DE and 16PE.
Results:
DE age is 66 years, PE age is 74 years, (p<0,02), 17 male (59%) in DE, eight in PE, 21 (72%) DE have a preexisting cardiopathy versus 15 (94%) PE, seven native valve and six prosthetic valve in PE, 11 native valve and nine prosthetic valve in DE. Twenty-six (90%) DE and 16 (100%) have fever, 14 (48%) DE and nine (56%) PE have a cardiac failure, one DE (3%) and 14 (87%) have no echographic sign of endocarditis (transthoracic echo or transthoracic and transesophagal echo) (p<0.001). Blood cultures are positive in 23DE (79%), and 14 (87%) PE (NS) Streptococcus and Enterococcus are the most common bacterial species (62%) in the two groups. Treatment duration is 64 days for DE and 43 days for PE, hospitalisation duration is 33 days for the DE and 27 days in PE.
Conclusions:
PE group and DE group are similar concerning fever cardiac failure, preexisting cardiopathy, blood cultures and bacterial species. PE group is older than DE group, echography is more often negative in PE group. A patient with a preexisting valvulopathy and a septicemia without echographic sign of endocarditis is the most frequent clinical pattern in PE.
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