title: Evaluation of the Duke criteria in 93 episodes of prosthetic valve endocarditis: could sensitivity be improved?
abstract: BACKGROUND
  Since publication of the Duke criteria for diagnosing endocarditis, several articles have confirmed their sensitivity when native and prosthetic valves are considered together.
  
  
  OBJECTIVE
  To compare the differences between the older von Reyn criteria and the Duke criteria in prosthetic valve endocarditis only, and to determine if the latter's sensitivity could be improved by adding 2 minor criteria: new-onset heart failure and presence of conduction disturbances.
  
  
  METHODS
  We retrospectively evaluated 93 episodes of prosthetic valve endocarditis from January 1986 to January 1998 in a teaching hospital, and then analyzed the 76 surgically confirmed episodes to compare the differences between the von Reyn and Duke diagnostic criteria.
  
  
  RESULTS
  The von Reyn criteria rejected the diagnosis in 16 of the confirmed episodes, compared with 1 diagnosis missed by the Duke criteria and 1 missed using our suggested modifications. Definite diagnosis (Duke) was established in 60 episodes, compared with a diagnosis of probable (von Reyn) in 36 episodes (P<.001). Our modifications improved the sensitivity of the Duke criteria, diagnosing 70 episodes as definite (P = .02).
  
  
  CONCLUSIONS
  As was the case with native valve endocarditis, the Duke criteria proved to be more sensitive than the von Reyn criteria in prosthetic valve endocarditis. The addition of 2 minor criteria (new-onset heart failure and presence of conduction disturbances) could improve the diagnostic sensitivity of the Duke criteria.
authors.affiliation: Department of Internal Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Vázquez
authors.forename: M C
authors.initials: MC
authors.lastname: Fariñas
authors.forename: J D
authors.initials: JD
authors.lastname: García-Palomo
authors.forename: J M
authors.initials: JM
authors.lastname: Bernal
authors.forename: J M
authors.initials: JM
authors.lastname: Revuelta
authors.forename: J
authors.initials: J
authors.lastname: González-Macías
mesh_terms: D000328:Adult; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity