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Diagnostic value of the modified Duke criteria in suspected infective endocarditis -The PRO-ENDOCARDITIS study
Amir A Mahabadi1, Ihab Mahmoud1, Iryna Dykun1
1Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Insights
Comorbidities do not significantly improve diagnosis of infective endocarditis (IE) when using modified Duke criteria alone. Transesophageal echocardiography is the primary driver for accurate IE diagnosis, significantly outperforming clinical criteria.
Area of Science:
- Cardiology
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Infective endocarditis (IE) diagnosis relies on clinical criteria.
- The role of comorbidities in stratifying IE risk and improving diagnosis is unclear.
- Modified Duke criteria are standard for IE evaluation.
Purpose of the Study:
- To assess if comorbidities improve IE diagnostic accuracy alongside modified Duke criteria.
- To evaluate the diagnostic performance of clinical factors versus echocardiography.
Main Methods:
- Prospective observational trial of 261 suspected IE patients.
- Assessment of modified Duke criteria, comorbidities, and clinical characteristics.
- Analysis using receiver operating characteristic (ROC) curves.
Main Results:
- IE patients showed higher rates of positive blood cultures, embolic diseases, murmurs, and ICU care.
- Modified Duke criteria alone had an area under the curve (AUC) of 0.783.
- Transesophageal echocardiography (TEE) alone achieved an AUC of 0.956, significantly higher than clinical criteria.
Conclusions:
- Modified Duke criteria offer good diagnostic value for suspected IE.
- Transesophageal echocardiography is the key component for accurate IE diagnosis.
- Adding comorbidities marginally improved diagnostic accuracy when TEE was not used.
Objectives:
To determine whether relevant comorbidities stratify patients with and without IE and whether these may improve the diagnostic accuracy, in addition to the modified Duke criteria.
Methods And Results:
261 consecutive patients (aged 60.1 ± 16.1 years, 62.8% male) with suspected IE were prospectively included in this single-center observational trial. Modified Duke criteria and relevant comorbidities as well as clinical characteristics, were assessed. Forty-seven patients had IE, as confirmed by a clinical event committee. Patients with IE had a higher frequency of positive blood cultures (70.2% vs. 36.9%, p < 0.0001), embolic diseases (36.2% vs. 10.8%, p < 0.0001), heart murmurs (27.7% vs. 11.7%, p = 0.01), and intensive care therapy (74.5% vs. 58.4%, p = 0.04). In receiver operating characteristics, the combination of modified Duke criteria without transesophageal echocardiography led to an area under the curve of 0.783 (0.715-0.851). The predictive value was only marginally improved by the addition of heart murmur and intensive care therapy (0.794 [0.724-0.863]). In contrast, transesophageal echocardiography alone achieved an area under the curve of 0.956 (0.937-0.977) and was further improved when adding modified Duke criteria, heart murmur, and intensive care therapy (0.999 [0.998-1.000]).
Conclusion:
Modified Duke criteria provide excellent diagnostic value for evaluating suspected IE, mainly driven by transesophageal echocardiography.
Trial Registration:
NCT03365193.
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