杜克标准、欧洲心脏病学会2015年标准、国际心血管感染病学会2023年标准以及欧洲心脏病学会2023年标准在经导管主动脉瓣置换术相关感染性心内膜炎诊断方面的比较。

Comparison between Duke, European Society of Cardiology 2015, International Society for Cardiovascular Infectious Diseases 2023, and European Society of Cardiology 2023 criteria for the diagnosis of transcatheter aortic valve replacement-related infective endocarditis.

作者信息

Boufoula Inès, Philip Mary, Arregle Florent, Tessonnier Laetitia, Camilleri Serge, Hubert Sandrine, Casalta Jean-Paul, Gouriet Frédérique, Camoin-Jau Laurence, Riberi Alberto, Lemrini Yassine, Mancini Julien, Lemaignen Adrien, Dion Fanny, Chane-Sone Nicolas, Lucas Claire, Renard Sébastien, Casalta Anne-Claire, Torras Olivier, Ambrosi Pierre, Collart Frédéric, Bernard Anne, Habib Gilbert

机构信息

Cardiology Department, Academic Hospital, Tours, France.

Cardiology Department, La Timone Academic Hospital, AP-HM, Marseille, France.

出版信息

Eur Heart J Cardiovasc Imaging. 2025 Mar 3;26(3):532-544. doi: 10.1093/ehjci/jeae310.

DOI:10.1093/ehjci/jeae310

PMID:39673426

Abstract

AIMS

Transcatheter aortic valve replacement-related infective endocarditis (TAVR-IE) is associated with a poor prognosis. TAVR-IE diagnosis is challenging, and benefits of the most recent classifications [European Society of Cardiology (ESC)-2015, International Society for Cardiovascular Infectious Diseases (ISCVID)-2023, and ESC-2023] have not been compared with the conventional Duke criteria on this population. The primary objective was to compare the diagnostic value of the Duke, ESC-2015, ISCVID-2023, and ESC-2023 criteria for the diagnosis of TAVR-IE. The secondary objectives were to determine which criteria increase the diagnostic accuracy of each classification and to evaluate in-hospital and 1-year mortality of TAVR-IE.

METHODS AND RESULTS

From January 2015 to May 2022, 92 patients with suspected TAVR-IE were retrospectively included in two French centres, including 82 patients with definite TAVR-IE and 10 patients with rejected TAVR-IE as defined by expert consensus. Duke classification yielded a sensitivity of 65% [95% confidence interval (CI): 53-75%] and a specificity of 100% (95% CI: 69-100%) for the diagnosis of TAVR-IE. ESC-2015 classification increased Duke criterion sensitivity from 65 to 73% (P = 0.016) but decreased specificity from 100 to 90%. ISCVID-2023 and ESC-2023 also increased Duke criterion sensitivity from 65 to 76% (P = 0.004) and 77% (P = 0.002), respectively, but also decreased specificity from 100 to 90%. A positive 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was the most helpful criterion, as 10 patients (11%) were correctly reclassified. In-hospital mortality after TAVR-IE was 21% and 1-year mortality was 38%.

CONCLUSION

A multimodality imaging approach, including 18F-FDG PET/CT and gated cardiac CT, is the cornerstone of TAVR-IE diagnosis and explains the higher sensitivity of ESC-2015 and recent classifications compared with Duke criteria.

摘要

目的

经导管主动脉瓣置换术相关感染性心内膜炎（TAVR-IE）预后较差。TAVR-IE的诊断具有挑战性，且尚未将最新分类标准[欧洲心脏病学会（ESC）-2015、国际心血管感染性疾病学会（ISCVID）-2023和ESC-2023]与该人群的传统杜克标准进行比较。主要目的是比较杜克、ESC-2015、ISCVID-2023和ESC-2023标准对TAVR-IE诊断的价值。次要目的是确定哪些标准可提高每种分类的诊断准确性，并评估TAVR-IE的院内和1年死亡率。

方法与结果

2015年1月至2022年5月，法国两个中心回顾性纳入92例疑似TAVR-IE患者，其中包括82例确诊的TAVR-IE患者和10例根据专家共识判定为排除TAVR-IE的患者。杜克分类法诊断TAVR-IE的敏感性为65%[95%置信区间（CI）：53-75%]，特异性为100%（95%CI：69-100%）。ESC-2015分类法将杜克标准的敏感性从65%提高到73%（P = 0.016），但特异性从100%降至90%；ISCVID-2023和ESC-2023也分别将杜克标准的敏感性从65%提高到76%（P = 0.004）和77%（P = 0.002），特异性同样从100%降至90%。18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）呈阳性是最有帮助的标准，因为有10例患者（11%）被正确重新分类；TAVR-IE后的院内死亡率为21%，1年死亡率为38%。