Table 1.
Integrating clinical and laboratory data for rational use of echocardiography in patients with suspected native valve infective endocarditis
| Clinical criteria for diagnosis of infective endocarditis (adapting Duke Criteria) |
| Major criteria |
| 1. Positive blood cultures for infective endocaritis: |
| a. Typical microorganisms for infective endocarditis, including viridans strep, S. bovis, HACEK or community acquired Staph aureus or enterococcus OR |
| b. Microorganisms from persistent positive blood cultures, at least two positive cultures drawn >12 hours apart |
| 2. Evidence of endocardial involvement: |
| a. New valvular regurgitation on clinical exam (worsening or changing of pre-existing murmur not sufficient) |
| Minor criteria |
| 1. Predisposition: predisposing heart condition or intravenous drug use |
| 2. Fever: temperature >38 C on two separate occasions |
| 3. Vascular phenomenon: major arterial emboli, septic pulmonary infarcts, mycotic aneurysms, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions |
| 4. Immunological phenomenon: glomerulonephritis, Osler's nodes, Roth's spots and rheumatoid arthritis |
| 5. Microbiological evidence: positive blood cultures but does not a meet a major criteria as defined above |
| 6. Serological evidence of active infection with organism consistent with endocarditis |
| High Likelihood: two major or one major and three minor clinical criteria |
| -Transthoracic and transesophageal echocardiography to assess prognosis or complications |
| Intermediate likelihood: one major or three minor clinical criteria |
| -TTE as initial test. If the echo is positive, then treat appropriately. |
| -TEE if the patient has high risk echocardiographic features on TTE or if clinical suspicion remains after negative or nondiagnostic TTE |
| Low likelihood: firm alternative diagnosis |
| -No echocardiography for diagnosis. Look for and treat alternative diagnosis |
Reproduced with permission from Jassal DS et al. Can structured clinical assessment using modified Duke's criteria improve appropriate use of echocardiography in patients with suspected infective endocarditis? Can J Cardiol 2003; 19 (9): 1017-22.