Background The 2023 Duke-ISCVID classification is a new diagnostic tool for infective endocarditis, updating the 2000 modified Duke and the 2015 ESC classifications. In comparison, its’ sensitivity is higher, however its’ specificity remains to be evaluated and compared to that of the two other classifications in endocarditis suspected patients. Methods We retrospectively collected the characteristics of patients hospitalized in Bichat University’s Hospital, Paris, in 2021, who had been evaluated for clinical suspicion of endocarditis, have had at least a transthoracic echocardiography, two pairs of blood cultures, 3-month follow-up and in whom endocarditis diagnosis was finally rejected. All patients were classified by 2000 modified Duke, 2015 ESC and 2023 Duke-ISCVID, as though the endocarditis diagnosis had not been rejected. Results In total, 130 patients’ charts were analyzed. Mean age was 62 years, 84 (64.6%) were male, 39 (30.0%) had prosthetic cardiac valve or valve repair, 21 (16.2%) cardiac implanted electronic device, and 30 (23.1%) other cardiac conditions. Overall, 5, 2 and 5 patients were falsely classified as definite endocarditis with the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID classifications, respectively. The corresponding specificities were 96.2% (95% CI [90.8%; 98.6%]), 98.5% (95% CI [93.9%; 99.7%]), and 96.2% (95% CI [90.8%; 98.6%]). The rates of possible endocarditis were of 38%, 35%, and 35% in the 3 classifications, respectively. Conclusion The 2023 Duke-ISCVID classification is highly specific for ruling out the diagnosis of definite infective endocarditis in patients who had been evaluated for IE.

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2023 年杜克国际心血管传染病学会感染性心内膜炎分类的特异性评估

背景 2023 年 Duke-ISCVID 分类是一种新的感染性心内膜炎诊断工具，更新了 2000 年修订的 Duke 分类和 2015 年 ESC 分类。相比之下，其敏感性较高，但其特异性仍有待评估，并与心内膜炎疑似患者中的其他两种分类进行比较。方法 我们回顾性收集了 2021 年在巴黎比夏大学医院住院的患者的特征，这些患者被评估为临床怀疑心内膜炎，至少进行过经胸超声心动图检查、两对血培养、3 个月随访和最终拒绝了心内膜炎的诊断。所有患者均按照 2000 年改良版 Duke、2015 年 ESC 和 2023 年 Duke-ISCVID 进行分类，就好像心内膜炎诊断并未被拒绝一样。结果 总共分析了 130 名患者的图表。平均年龄为 62 岁，84 名 (64.6%) 为男性，39 名 (30.0%) 接受过人工心脏瓣膜或瓣膜修复术，21 名 (16.2%) 名心脏植入电子装置，以及 30 名 (23.1%) 患有其他心脏疾病。总体而言，根据 2000 年修订版 Duke、2015 年 ESC 和 2023 年 Duke-ISCVID 分类，分别有 5、2 和 5 名患者被错误地分类为明确的心内膜炎。相应的特异性为 96.2% (95% CI [90.8%; 98.6%])、98.5% (95% CI [93.9%; 99.7%]) 和 96.2% (95% CI [90.8%; 98.6%])。 3种分类中可能发生心内膜炎的比例分别为38%、35%和35%。结论 2023 年 Duke-ISCVID 分类对于排除已接受 IE 评估的患者明确感染性心内膜炎的诊断具有高度特异性。