Vivancos Delgado R, Barakat S, Alvarez Rubiera J, Sánchez Calle J M, Delgado J L, Rubio Alcaide A, Urda Valcárcel T, de Mora Martín M, Malpartida de Torres F
Servicio de Cardiología, Hospital Regional Carlos Haya, Málaga.
Rev Esp Cardiol. 1998;51 Suppl 2:29-39.
The Von Reyn criteria determine only a small number of definitive diagnoses of infectious endocarditis, while it is mainly diagnosed by histopathological confirmation in surgery or autopsy. This necessitates carrying out a new diagnostic scheme with accurate sensitivity and specificity based on rigorous clinical support. This scheme is provided by the Duke University criteria, which enhance the role of conventional and transesophageal echocardiography, in the diagnosis of infectious endocarditis. Echocardiography is the only accurate procedure for a non invasive diagnosis of vegetation, the main lesion in this pathology. Often, tissue destruction causes regurgitation, which is responsible for hemodynamic impairment or allows the spread of the infectious process to perivalvular tissue and can form an abscess. These complications and many others, which are difficult to treat, require an early diagnosis of this disease. Sensitivity of transesophageal technique to detect vegetations and complications is higher than that observed in conventional echocardiography, above all in patients with prosthetic valves. If the transesophageal study is negative, the existence of an infectious endocarditis is quite unlikely. Nevertheless, we need to consider clinical features, as the specificity of this technique is moderate.
冯·雷诺标准仅能确定少数明确的感染性心内膜炎诊断，而该病主要通过手术或尸检中的组织病理学确诊。因此，有必要基于严格的临床支持制定一种具有准确敏感性和特异性的新诊断方案。杜克大学标准提供了这样一种方案，该标准增强了传统超声心动图和经食管超声心动图在感染性心内膜炎诊断中的作用。超声心动图是对该病主要病变——赘生物进行无创诊断的唯一准确方法。组织破坏常导致反流，进而引起血流动力学损害，或使感染过程扩散至瓣周组织并形成脓肿。这些并发症以及许多其他难以治疗的并发症需要对该病进行早期诊断。经食管技术检测赘生物和并发症的敏感性高于传统超声心动图，尤其是在人工瓣膜患者中。如果经食管检查结果为阴性，则感染性心内膜炎的存在可能性极小。然而，由于该技术的特异性中等，我们仍需考虑临床特征。
