Role of the New Physical Examination Minor Criterion (New Heart Murmur) for the Diagnosis of Infective Endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Clinical Diagnostics

Background:

• Infective endocarditis (IE) is a serious infection requiring accurate diagnosis.
• The Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) criteria are widely used for IE diagnosis.
• Evaluating the diagnostic performance of the updated 2023 Duke-ISCVID criteria is essential.

Purpose of the Study:

• To assess the diagnostic accuracy of the 2023 Duke-ISCVID clinical criteria for infective endocarditis.
• To evaluate the impact of excluding specific criteria (imaging, surgical findings, physical examination) on diagnostic accuracy.

Main Methods:

• Retrospective analysis of 3127 episodes of suspected infective endocarditis.
• Application of the 2023 Duke-ISCVID criteria to classify cases.
• Comparison of diagnostic accuracy with and without specific criterion subsets.

Main Results:

• The 2023 Duke-ISCVID criteria demonstrated a 90% accuracy for IE diagnosis.
• A new heart murmur, a physical examination finding, was present in 22% of episodes.
• Excluding imaging and surgical findings reduced accuracy to 73%; including only physical examination yielded 78% accuracy.

Conclusions:

• The 2023 Duke-ISCVID criteria offer high accuracy for diagnosing infective endocarditis.
• Physical examination findings, particularly new heart murmurs, are important but insufficient alone.
• Comprehensive application of the criteria, including imaging and surgical data, is vital for optimal diagnostic performance.