Key result
Compared with Duke criteria (sensitivity 65%), the ESC-2015, ISCVID-2023, and ESC-2023 criteria significantly increased sensitivity for diagnosing TAVR-IE to 73%, 76%, and 77%, respectively.
Why the study?
Diagnosis of TAVR-IE is challenging, and the benefits of recent classifications (ESC-2015, ISCVID-2023, and ESC-2023) had not been compared with conventional Duke criteria in this population.
Do ESC-2015, ISCVID-2023, and ESC-2023 criteria improve diagnostic sensitivity for TAVR-IE compared to conventional Duke criteria in patients with suspected TAVR-IE?
Observational (n=92)
Yes
Do ESC-2015, ISCVID-2023, and ESC-2023 criteria improve diagnostic sensitivity for TAVR-IE compared to conventional Duke criteria in patients with suspected TAVR-IE?
Absolute Event Rate: 77% vs 65%
p-value: p=0.002
Recent diagnostic classifications incorporating multimodality imaging (ESC-2015, ISCVID-2023, ESC-2023) improve sensitivity but slightly reduce specificity compared to conventional Duke criteria for diagnosing TAVR-IE.
Newer criteria raise TAVR-IE sensitivity at the expense of specificity; leaves open need for prospective validation before changing practice.
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.
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Boufoula et al. (2024) conducted an observational in Transcatheter aortic valve replacement-related infective endocarditis (TAVR-IE) (n=92). ESC-2015, ISCVID-2023, and ESC-2023 criteria vs. Duke criteria was evaluated on Sensitivity for the diagnosis of TAVR-IE (p=0.002). Compared with Duke criteria (sensitivity 65%), the ESC-2015, ISCVID-2023, and ESC-2023 criteria significantly increased sensitivity for diagnosing TAVR-IE to 73%, 76%, and 77%, respectively.
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