Diagnosis of Infective Endocarditis: Evaluation of two Different Criteria

pp 57-63

Abstract

Background

Infective endocarditis remains a difficult disease to diagnose with certainty due to the highly variable and sometimes nonspecific nature of the clinical and laboratory findings.

Objectives

The aim of this study was to compare the von Reyn versus the Duke criteria in 61 patients who had pathologically confirmed infective endocarditis.

Method

A total of 294 consecutive suspected infective endocarditis cases in 285 patients were evaluated overa 18 months period. These cases were prospectively enrolled in the multicenter Argentine Infective Endocarditis Trial (EIRA). Sixty-one proven cases (32 by surgery and 29 by autopsy) were reclassified after exclusion of these findings, enabling comparison of clinical diagnostic criteria in proven cases. The von Reyn criteria (probable, possible and rejected) were compared with the analogous categories in Duke criteria (definite, possible and rejected).

Results

With the von Reyn criteria the 61 infective endocarditis were classified as: probable 27 (44%), possible 15 (25%) and rejected 19 (31%) and with the Duke ones: definite 56 (92%), possible 5 (8%) and none was rejected (p < 0.00004). The contribution of each major Duke criteria in the diagnosis of the 56 definite infective endocarditis patients was:1) evidence of endocardial involvement: a) vegetations by 2-dimensional (2-D) echocardiogram 52/56 (95%), b) new regurgitant murmur 30/56 (54%) and 2) positive blood culture 41/56 (73%). In the 20suspected infective endocarditis with negative blood cultures the Duke criteria were also more effective in the diagnosis of clinically definite infective endocarditis; von Reyn: probable 1, possible 5, and rejected 14; Duke: definite 16, possible 4 and rejected 0 (p < 0.00001).

Conclusion

The Duke criteria were superior to the von Reyn criteria for the clinical diagnosis of infective endocarditis, principally in patients with negative blood culture, predominantely reflecting use of 2-D echocardiographic demonstration of valvular vegetations.