Comparison between the Duke Criteria Versus the Von Reyn Criteria for the Diagnosis of Infective Endocarditis and the Usefulness of Transesophageal Echocardiography

Kim, Baek Nam; Kim, Yang Soo

Abstract

BACKGROUND: We compared the sensitivity and specificity of the newly developed Duke criteria (D) with those of the von Reyn criteria (R), and also evaluated the usefulness of transesophageal echocardiography (TEE) for the diagnosis of infective endocarditis (IE).
METHODS
We retrospectively reclassified 99 cases of infective endocarditis either by the Duke criteria or by the von Reyn criteria, according to clinical, microbiologic, and echocardiographic findings.
RESULTS
Of 27 histologically confirmed cases, the sensitivity of D (22 definite + 5 possible) was 100%, and that of R (6 probable + 13 possible) was 70.4% (p< 0.05). Of 7 histologically rejected cases, there were 6 possible cases falsely accepted as IE by D, but none were accepted by R (p<0.05). For the histologically confirmed cases, the sensitivity of D was not improved by TEE (23/23, 100%) compared with TTE (23/23, 100%). For 7 histologically rejected cases, the false-positive rate of TEE (5/7, 85.7%) was higher than that of TTE (2/7, 33.3%). There were 2 rejected cases by R compared with 0 by D among 34 cases of IE caused by viridans streptococci (p<0.05). And there were 5 rejected cases by R compared with 0 by D among 11 cases caused by S. aureus.
CONCLUSION
The Duke criteria was more sensitive, but less specific than the von Reyn criteria for the diagnosis of IE. TEE may be helpful, but are not specific. The usefulness of TEE should be further evaluated.