2023年感染性心内膜炎诊断标准在携带与未携带心脏植入电子装置患者中的诊断性能
该前瞻性多中心队列研究纳入1180例接受感染性心内膜炎（IE）治疗的患者，比较2023年ESC、2015年ESC、2019年EHRA及2023年Duke-ISCVID标准在携带或不携带心脏植入电子装置（CIED）患者中的诊断性能。结果显示，在CIED患者中2023年ESC和Duke-ISCVID标准敏感性更高但特异性明显降低，尤其对于导线IE；2019年EHRA标准在CIED患者中准确性最高。
要点
- 在CIED患者中，2023年ESC和Duke-ISCVID标准敏感性高但特异性低，尤其导线IE患者特异性更低。
- 2019年EHRA标准在CIED患者中准确性最高，导线IE患者中特异性仍达67.6%。
- 无CIED患者中所有标准敏感性均超过96%，2023年ESC标准特异性为48.0%。
核心结论
- 在CIED患者中，2023年ESC和2023年Duke-ISCVID标准较2015年ESC标准敏感性更高但特异性更低，尤其对于导线IE患者。
- 在CIED患者中，2019年EHRA标准准确性最高。
研究设计与样本
- 以专家独立裁定的「确定IE」为金标准，计算各标准的敏感性、特异性和准确性。
主要发现
- 在269例CIED患者中，208例（77.3%）被裁定为「确定IE」；2023年Duke-ISCVID和2023年ESC标准的敏感性分别为97.1%和93.8%，特异性分别为31.1%和41.0%。
- 在159例CIED合并导线IE患者中（78.6%为「确定IE」），2023年Duke-ISCVID和2023年ESC标准的特异性分别为11.8%和32.4%，而2019年EHRA标准特异性为67.6%。
- 在911例无CIED患者中（81.0%为「确定IE」），所有标准敏感性均超过96%，2015年ESC、2023年Duke-ISCVID和2023年ESC标准的特异性分别为55.5%、52.6%和48.0%。
关键数值与推荐
- 导线IE的怀疑标准定义为：影像学显示心脏导线感染的特定解剖或代谢特征；或无非瓣膜赘生物的肺栓塞；或心脏开胸手术中拔除导线培养阳性。
临床怎么用
- 在CIED患者中，尤其怀疑导线IE时，需注意2023年ESC和Duke-ISCVID标准特异性较低，可能增加假阳性。
- 2019年EHRA标准在CIED患者中准确性最高，可优先考虑用于CIED相关IE的诊断。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: The European Society of Cardiology (ESC) diagnostic criteria for infective endocarditis (IE) were updated in 2023. Using a prospective multicentre cohort of patients treated for IE, we compared the performance of the 2023 ESC classification to that of 2015 ESC, 2019 European Heart Rhythm Association (EHRA) and 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) classifications in patients with or without cardiac implantable electronic devices (CIEDs). METHODS: A total of 1180 patients treated for IE between January 2017 and October 2022 were categorised as having either definite or possible/rejected IE within each classification. The gold standard diagnosis of IE was independently adjudicated by experts as 'certain' or not. Definite and 'certain' cases of IE were cross-tabulated to calculate sensitivity, specificity and accuracy.Suspicion of lead IE was defined by specific anatomical or metabolic features of cardiac lead infection on imaging; or by pulmonary embolism without valvular vegetation; or by positive culture of a lead extracted during open-heart surgery. RESULTS: In the 269 patients with CIEDs, 208 (77.3%) were adjudicated as 'certain IE'; 2023 Duke-ISCVID and 2023 ESC classifications achieved higher sensitivity (97.1% and 93.8%, respectively) but markedly lower specificity (31.1% and 41.0%, respectively) than 2015 ESC and 2019 EHRA classifications.In the 159 patients with CIEDs and lead IE (78.6% 'certain IE'), while sensitivity remained high for all classifications, specificity dropped for 2023 Duke-ISCVID and 2023 ESC classifications (11.8% and 32.4%, respectively), but not for 2019 EHRA classification (67.6%).In the 911 patients without CIEDs (81.0% 'certain IE'), sensitivity was higher than 96% for all classifications and specificity was 55.5%, 52.6% and 48.0% for 2015 ESC, 2023 Duke-ISCVID and 2023 ESC classifications, respectively. CONCLUSIONS: The 2023 ESC and 2023 Duke-ISCVID classifications had a higher sensitivity but a lower specificity than the 2015 ESC classification in patients with CIEDs, especially among those with lead IE. In patients with CIEDs, the 2019 EHRA classification was the most accurate.
引用
- Selton-Suty C, Lalloué B, Goehringer F, et al. Diagnostic performance of 2023 endocarditis criteria in patients with and without cardiac implantable electronic devices. Heart. 2026. PMID: 41218924. doi:10.1136/heartjnl-2025-326357
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。