NEW CRITERIA FOR DIAGNOSIS OF INFECTIVE ENDOCARDITIS - UTILIZATION OFSPECIFIC ECHOCARDIOGRAPHIC FINDINGS

PURPOSE: This study was designed to develop improved criteria for the diagnosis of infective endocarditis and to compare these criteria with currently accepted criteria in a large series of cases. PATIENTS AND METHODS: A total of 405 consecutive cases of suspected infective endoc arditis in 353 patients evaluated in a tertiary care hospital from 198 5 to 1992 were analyzed using new diagnostic criteria for endocarditis . We defined two ''major criteria'' (typical blood culture and positiv e echocardiogram) and six ''minor criteria'' (predisposition, fever, v ascular phenomena, immunologic phenomena, suggestive echocardiogram, a nd suggestive microbiologic findings). We also defined three diagnosti c categories: (1) ''definite'' by pathologic or clinical criteria, (2) ''possible,'' and (3) ''rejected.'' Each suspected case of endocardit is was classified using both old and new criteria. Sixty-nine patholog ically proven cases were reclassified after exclusion of the surgical or autopsy findings, enabling comparison of clinical diagnostic criter ia in proven cases. RESULTS: Fifty-five (80%) of the 69 pathologically confirmed cases were classified as clinically definite endocarditis. The older criteria classified only 35 (51%) of the 69 pathologically c onfirmed cases into the analogous probable category (p <0.0001). Twelv e (17%) pathologically confirmed cases were rejected by older clinical criteria, but none were rejected by the new criteria. Seventy-one (21 %) of the remaining 336 cases that were not proven pathologically were probable by older criteria, whereas the new criteria almost doubled t he number of definite cases, to 135 (40%, p <0.01). Of the 150 cases r ejected by older criteria, 11 were definite, 87 were possible, and 52 were rejected by the new criteria. CONCLUSION: Application of the prop osed new criteria increases the number of definite diagnoses. This sho uld be useful for more accurate diagnosis and classification of patien ts with suspected endocarditis and provide better entry criteria for e pidemiologic studies and clinical trials.