The role of echocardiography in suspected infective endocarditis (original) (raw)
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Clujul Med., 2015
Background and aims. In the absence of classical features (fever, cardiac murmur, and peripheral vascular stigmata) the diagnosis of infective endocarditis (IE) may be difficult.Current clinical guidelines for the diagnosis and management of IE recommend the use of modified Duke criteria. Correct and prompt diagnosis of IE is crucial for the treatment and outcome of the patients. The aim of this study was to evaluate the presence and the individual value of each criterion of the modified Duke criteria in our patients with infective endocarditis. Methods. We performed a prospective observational study between January 2008-June 2014, in which we enrolled consecutive adult patients admitted for suspicion of IE to the Hospital of Infectious Diseases and at the Heart Institute. We used and extensive database in order to collect demographic data, laboratory and echocardiography results, evolution and outcome of the patients. Using the modified Duke criteria we identified 3 categories of IE: definite, possible and rejected. In order to evaluate the importance of each criterion in the diagnosis of IE we tested two hypotheses. First, we excluded each criterion from the final diagnosis and we counted how many cases felt into a lower category. Second, after adding each major and minor criterion, we tested how many cases would have been classifiable as definite IE. Results. The study included 241 adult patients with a mean age 58.16 years and sex ratio male/female 1.94. According to the modified Duke criteria 137 patients had definite IE, 79 patients had possible IE and 25 cases had rejected IE We had blood cultures positive IE in 109 cases and blood culture negative IE (BCNE) in 132 (71.21%) cases. Antibiotic treatment prior to blood culture was recorded in 152 (63.07%) patients. In the absence of the echocardiography major criterion, 43% of cases would become possible. After extraction of major microbiological criterion, only one third of definite cases would become possible. Minor criteria such as fever and predisposition contributed to the diagnosis only in 10% of cases. In the presence of vascular or immunological phenomena, or in the presence of minor microbiological criterion, half of the possible IE cases could become possible. Conclusion. Twenty-years after their launch, the Duke criteria for the diagnosis of IE continue to be important tools. Low index of suspicion of IE and inappropriate use of antibiotics may have a great negative impact on the diagnosis of IE. Nowadays, the scarcity of classical Osler manifestations-bacteremia, fever and peripheral stigmata-makes the diagnosis of IE a challenge.
Value and limitations of the duke criteria for the diagnosis of infective endocarditis
Journal of the American College of Cardiology, 1999
The purpose of this study was to assess the value and limitations of Duke criteria for the diagnosis of infective endocarditis (IE). BACKGROUND Duke criteria have been shown to be more sensitive in diagnosing IE than the von Reyn criteria, but the diagnosis of IE remains difficult in some patients. METHODS Both classifications were applied in 93 consecutive patients with pathologically proven IE. Blood cultures, and transthoracic and transesophageal echocardiography were performed in all patients. RESULTS Sensitivities for the diagnosis of IE were 56% and 76% for von Reyn and Duke criteria, respectively. Fifty-two patients were correctly classified as "probable IE" by von Reyn and "definite IE" by Duke criteria (group 1). However, discrepancies were observed in 41 patients. Eleven patients (group 2) were misclassified as "rejected" by von Reyn, but were "definite IE" by Duke criteria; this difference could be explained by negative blood cultures and positive echocardiogram in all patients. In eight patients (group 3), the diagnosis of IE was "possible" by von Reyn but "definite" by Duke criteria. This difference was essentially explained by the failure of the von Reyn classification to consider echocardiographic abnormalities as major criteria. Twenty-two patients (group 4) were misclassified as possible IE using Duke criteria, being false negative of this classification. Echocardiographic major criteria were present in 19 patients, but blood cultures were negative in 21 patients. The cause of negative blood cultures was prior antibiotic therapy in 11 patients and Q-fever endocarditis diagnosed by positive serology in three cases. CONCLUSIONS Twenty-four percent of patients with proved IE remain misclassified as "possible IE" despite the use of Duke criteria, especially in cases of culture-negative and Q-fever IE. Increasing the diagnostic value of echographic criteria in patients with prior antibiotic therapy and typical echocardiographic findings and considering the serologic diagnosis of Q fever as a major criterion would further improve the clinical diagnosis of IE.
Criteria for the Diagnosis of Endocarditis and the Role of Echocardiography
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 1995
When infective endocarditis is a diagnostic possibility, echocardiography permits noninvasive imaging of cardiac structures. As involvement of the endocardium is a sine qua non of endocarditis, echocardiography may assist in its diagnosis by demonstrating such involvement. The ability of echocardiography to detect the intracardiac manifestations of infective endocarditis has continued to improve, especially with the introduction of transesophageal imaging. This article will discuss some of the echocardiographic findings in endocarditis and elucidate the incorporation of these findings in the new Duke criteria for the diagnosis of endocarditis.
Clujul Medical, 2015
Background and aims. In the absence of classical features (fever, cardiac murmur, and peripheral vascular stigmata) the diagnosis of infective endocarditis (IE) may be difficult.Current clinical guidelines for the diagnosis and management of IE recommend the use of modified Duke criteria. Correct and prompt diagnosis of IE is crucial for the treatment and outcome of the patients.The aim of this study was to evaluate the presence and the individual value of each criterion of the modified Duke criteria in our patients with infective endocarditis.Methods. We performed a prospective observational study between January 2008 – June 2014, in which we enrolled consecutive adult patients admitted for suspicion of IE to the Hospital of Infectious Diseases and at the Heart Institute . We used and extensive database in order to collect demographic data, laboratory and echocardiography results, evolution and outcome of the patients. Using the modified Duke criteria we identified 3 categories of ...
Pathology of infective endocarditis. A postmortem evaluation
British heart journal, 1973
A review of 28 necropsy cases of infective endocarditis seen over the 12-month period of I969 is presented. The infection involved a previously apparently normal valve in I6 cases (57%). Isolated aortic valve endocarditis was the commonest lesion and was found in i5 cases. Infective endocarditis of the aortic valve characteristically occurred on a nornal valve in middle-aged men. In the IO cases of isolated mitral endocarditis evidence of previous abnormality, rheumatic disease or endomyocardial fibrosis, was usually present. Blood
Clinical, echocardiographic, and operative findings in active infective endocarditis
Heart, 1982
Clinical and echocardiographic findings were compared with those found at operation in 18 consecutive patients with active endocarditis undergoing valve replacement for continuing left ventricular failure. A close correlation was shown between vegetations detected by echocardiography and those found at operation. In 10 of 11 patients with clinically suspected severe aortic regurgitation and vegetations only on the aortic valve and in two of three patients with severe mitral regurgitation echocardiography provided confirmation of the clinical diagnosis. In the three patients with clinically suspected aortic and mitral regurgitation, however, cardiac catheterisation was necessary to confirm the severity ofthe valvular regurgitation. In a further three patients cardiac catheterisation was carried out as the severity of the single valve lesion was difficult to assess or there were associated problems, that is chest pain with myocardial infarction and a sinus of Valsalva aneurysm. Four patients had either an abscess, annular infection, a sinus, or a ventricular septal defect at the time of operation, which were not detected by echocardiography. Nevertheless, because of their size it would be doubtful if these would have been identified by cardiac catheterisation. Echocardiography allowed repeated assessment of the patient so that the optimal time for operation could be determined without the risks ofleft heart catheterisation. Fourteen ofthe 18 patients (78%) survived to leave hospital. The follow-up extended to 44 months. During this time reinfection, prosthetic dehiscence, or paravalvular leaks did not occur. Thus, in the majority of patients with left sided active infective endocarditis and continuing left ventricular failure resulting from severe valvular disease the clinical findings together with echocardiography provide a satisfactory preoperative assessment.
The Full Spectrum of Infective Endocarditis: Case Report and Review
Case Reports in Cardiology
Over the past five decades, the incidence of intravenous drug use- (IVDU-) associated infective endocarditis (IE) has been on the rise in North America. Classically, IVDU has been thought to affect right-sided valves. However, in recent times a more variable presentation of IVDU-associated IE has been reported. Here, we report a case of a patient with a known history of IVDU who presented with clinical symptoms concerning for right- as well as left-sided endocarditis. In addition, we also discuss what should be considered adequate evaluation for patients with suspected endocarditis, and more specifically, what should be the role of transesophageal echocardiography in patients with IE noted on transthoracic echocardiography.