This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (18)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Could Sensitivity Be Improved?

Alberto Pérez-Vázquez, MD; M. Carmen Fariñas, MD, PhD; J. Daniel García-Palomo, MD, PhD; J. M. Bernal, MD, PhD; J. Manuel Revuelta, MD, PhD; Jesús González-Macías, MD, PhD

Arch Intern Med. 2000;160:1185-1191.

Background  Since publication of the Duke criteria for diagnosing endocarditis, several articles have confirmed their sensitivity when native and prosthetic valves are considered together.

Objectives  To compare the differences between the older von Reyn criteria and the Duke criteria in prosthetic valve endocarditis only, and to determine if the latter's sensitivity could be improved by adding 2 minor criteria: new-onset heart failure and presence of conduction disturbances.

Methods  We retrospectively evaluated 93 episodes of prosthetic valve endocarditis from January 1986 to January 1998 in a teaching hospital, and then analyzed the 76 surgically confirmed episodes to compare the differences between the von Reyn and Duke diagnostic criteria.

Results  The von Reyn criteria rejected the diagnosis in 16 of the confirmed episodes, compared with 1 diagnosis missed by the Duke criteria and 1 missed using our suggested modifications. Definite diagnosis (Duke) was established in 60 episodes, compared with a diagnosis of probable (von Reyn) in 36 episodes (P<.001). Our modifications improved the sensitivity of the Duke criteria, diagnosing 70 episodes as definite (P=.02).

Conclusions  As was the case with native valve endocarditis, the Duke criteria proved to be more sensitive than the von Reyn criteria in prosthetic valve endocarditis. The addition of 2 minor criteria (new-onset heart failure and presence of conduction disturbances) could improve the diagnostic sensitivity of the Duke criteria.

From the Infectious Diseases Unit, Departments of Internal Medicine (Drs Pérez-Vázquez, Fariñas, García-Palomo, and González-Macías) and Cardiovascular Surgery (Drs Bernal and Revuelta), Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC)
Endorsed by the European Society of Clinical Micro et al.
Eur Heart J 2009;30:2369-2413.
FULL TEXT  

Use of mitral homograft to support a mechanical valve prosthesis: a feasible solution for recurrent mitral valve dysfunction.
Bernal et al.
J. Thorac. Cardiovasc. Surg. 2009;137:762-763.
FULL TEXT  

Surgical Treatment of Mitral Valve Endocarditis
Stamou et al.
Card Surg Adult 2008;3:1069-1078.
FULL TEXT  

Contemporary Clinical Profile and Outcome of Prosthetic Valve Endocarditis
Wang et al.
JAMA 2007;297:1354-1361.
ABSTRACT | FULL TEXT  

Risk Factors of Prosthetic Valve Endocarditis: A Case-Control Study
Farinas et al.
Ann. Thorac. Surg. 2006;81:1284-1290.
ABSTRACT | FULL TEXT  

Molecular diagnosis of culture negative infective endocarditis: clinical validation in a group of surgically treated patients
Grijalva et al.
Heart 2003;89:263-268.
ABSTRACT | FULL TEXT  

Infective Endocarditis in Adults
Mylonakis and Calderwood
NEJM 2001;345:1318-1330.
FULL TEXT