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
Cardiology Department, Academic Hospital, Tours, France.
Cardiology Department, La Timone Academic Hospital, AP-HM, Marseille, France.
Eur Heart J Cardiovasc Imaging. 2025 Mar 3;26(3):532-544. doi: 10.1093/ehjci/jeae310.
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.
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%.
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.
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。
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%。
包括18F-FDG PET/CT和门控心脏CT在内的多模态成像方法是TAVR-IE诊断的基石，这解释了ESC-2015及近期分类标准相比杜克标准具有更高敏感性的原因。
