Evolution and interpretation of diagnostic criteria for infective endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QING Hongkun ¹ , WANG Weiteng ² ,  JIAN Xuhua ¹

1. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510010, P. R. China;
2. Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China;

Corresponding?author：

JIAN Xuhua, Email: jianxuhua@gdph.org.cn

Keywords：

Infective endocarditis; diagnostic criteria; modified Duke criteria; 2023 Duke-ISCVID criteria

DOI：

10.7507/1007-4848.202403049

Video：

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Infective endocarditis (IE) is a life-threatening infectious disease. Although histopathological examination remains the gold standard for definitive diagnosis, it is performed in only a minority of patients; thus, the diagnosis of IE continues to rely predominantly on clinical manifestations. However, IE presents with highly variable systemic symptoms that often lack cardiac-specific features, posing significant diagnostic challenges. To address this complexity, multiple diagnostic criteria have been developed, integrating clinical presentation, imaging findings, and microbiological evidence. Over the past three decades, substantial shifts in the microbiological and epidemiological profiles of IE, coupled with advances in imaging modalities and laboratory diagnostics, have profoundly influenced diagnostic approaches, driving continuous refinement of diagnostic criteria. This review provides a comprehensive overview of the major diagnostic criteria for IE, traces their historical evolution, evaluates recent updates and diagnostic performance, and offers theoretical insights and practical implications to guide future research.

Citation： QING Hongkun, WANG Weiteng, JIAN Xuhua. Evolution and interpretation of diagnostic criteria for infective endocarditis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(1): 30-36. doi: 10.7507/1007-4848.202403049 Copy

1.	Dayer MJ, Quintero-Martinez JA, Thornhill MH, et al. Recent insights into native valve infective endocarditis: JACC Focus Seminar 4/4. J Am Coll Cardiol, 2024, 83(15): 1431-1443.
2.	Cuervo G, Quintana E, Regueiro A, et al. The clinical challenge of prosthetic valve endocarditis: JACC Focus Seminar 3/4. J Am Coll Cardiol, 2024, 83(15): 1418-1430.
3.	Habib G, Erba PA, Iung B, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J, 2019, 40(39): 3222-3232.
4.	AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, Pettersson GB, Coselli JS, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg, 2017, 153(6): 1241-1258.
5.	de Leau MM, Kuipers RS. Cardiovascular complications of Streptococcus pneumoniae bacteraemia. BMJ Case Rep, 2021, 14(4): e240341.
6.	Erdem H, Baymakova M, Alkan S, et al. Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study. Eur J Clin Microbiol Infect Dis, 2023, 42(4): 387-398.
7.	Zmaili M, Alzubi J, Lo Presti Vega S, et al. Non-bacterial thrombotic endocarditis: a state-of-the-art contemporary review. Prog Cardiovasc Dis, 2022, 74: 99-110.
8.	Venepally NR, Arsanjani R, Agasthi P, et al. A new insight into nonbacterial thrombotic endocarditis: a systematic review of cases. Anatol J Cardiol, 2022, 26(10): 743-749.
9.	Alfatlawi H, Alharbi A, Shah M, et al. The impact of Libman-sacks endocarditis on inpatient outcomes with systemic lupus erythematosus: a retrospective study. Lupus, 2024, 33(7): 693-699.
10.	Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
11.	Von Reyn CF, Levy BS, Arbeit RD, et al. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med, 1981, 94(4 pt 1): 505-518.
12.	Pelletier LL Jr, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963-72. Medicine, 1977, 56(4): 287-313.
13.	Tissières P, Gervaix A, Beghetti M, et al. Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children. Pediatrics, 2003, 112(6 Pt 1): e467.
14.	Hoen B, Selton-Suty C, Danchin N, et al. Evaluation of the Duke criteria versus the Beth Israel criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 1995, 21(4): 905-909.
15.	錢杰, 高潤霖, 熊長明, 等. 感染性心內膜炎93例臨床分析及兩種國際診斷標準的比較. 中華心血管病雜志, 2003, 31(10): 27-30.Qian J, Gao RL, Xiong CM, et al. Clinical analysis of 93 cases of pathologically confirned infective endocarditis and comparisonbetween two international diagnostie criteria. Chin J Cardiol, 2003, 31(10): 27-30.
16.	Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med, 1994, 96(3): 200-209.
17.	Stockheim JA, Chadwick EG, Kessler S, et al. Are the Duke criteria superior to the Beth Israel criteria for the diagnosis of infective endocarditis in children? Clin Infect Dis, 1998, 27(6): 1451-1456.
18.	Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 2000, 30(4): 633-638.
19.	Hill EE, Herijgers P, Claus P, et al. Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study. Am Heart J, 2007, 154(5): 923-928.
20.	中華醫學會兒科學分會心血管學組, 中華兒科雜志編輯委員會. 小兒感染性心內膜炎的診斷標準 (試行). 中華兒科雜志, 2001, 39(5): 57.Group of Cardiology, Society of Pediatrics, Chinese Medical Association; Editorial Committee of Chinese Journal of Pediatrics. Diagnostic criteria for pediatric infective endocarditis (provisional). Chin J Pediatr, 2001, 39(5): 57.
21.	陳凡, 錢志勇, 彭志勇, 等. 感染性心內膜炎兩種診斷標準的比較研究. 中國現代醫學雜志. 2010, 20(1): 69-72.Chen F, Qian ZY, Peng ZY, et al. A comparative study of two diagnostic criteria for infective endocarditis. Chin J Mod Med, 2010, 20(1): 69-72.
22.	王國華, 吳弘, 秦永文, 等. 中國標準和Duke標準診斷感染性心內膜炎比較研究中國心血管病研究. 2007, 5(7): 481-484.Wang GH, Wu H, Qin YW, et al. Comparing the diagnostic value of the Chinese criteria and the Duke criteria for infective endocarditis in medical pract. Chin J Cardiovasc Rew, 2007, 5(7): 481-484.
23.	Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
24.	Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified duke criteria. Clin Infect Dis, 2023, 77(4): 518-526.
25.	Chen H, Yin Y, Gao H, et al. Clinical utility of in-house metagenomic next-generation sequencing for the diagnosis of lower respiratory tract infections and analysis of the host immune response. Clin Infect Dis, 2020, 71(Suppl 4): S416-S426.
26.	Papadimitriou-Olivgeris M, Monney P, Frank M, et al. Evaluation of the 2023 Duke-International Society of Cardiovascular Infectious Diseases criteria in a multicenter cohort of patients with suspected infective endocarditis. Clin Infect Dis, 2024, 78(4): 949-955.
27.	Lindberg H, Berge A, Jovanovic-Stjernqvist M, et al. Performance of the 2023 Duke-International Society of Cardiovascular Infectious Diseases diagnostic criteria for infective endocarditis in relation to the modified duke criteria and to clinical management-reanalysis of retrospective bacteremia cohorts. Clin Infect Dis, 2024, 78(4): 956-963.
28.	Goehringer F, Lalloué B, Selton-Suty C, et al. Compared performance of the 2023 Duke-International Society for Cardiovascular Infectious Diseases, 2000 modified Duke, and 2015 European Society of Cardiology criteria for the diagnosis of infective endocarditis in a French multicenter prospective cohort. Clin Infect Dis, 2024, 78(4): 937-948.
29.	van der Vaart TW, Bossuyt PMM, Durack DT, et al. External validation of the 2023 Duke-International Society for Cardiovascular Infectious Diseases diagnostic criteria for infective endocarditis. Clin Infect Dis, 2024, 78(4): 922-929.
30.	Cecchi E, Parrini I, Chinaglia A, et al. New diagnostic criteria for infective endocarditis. A study of sensitivity and specificity. Eur Heart J, 1997, 18(7): 1149-1156.
31.	Habib G, Derumeaux G, Avierinos JF, et al. Value and limitations of the Duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol, 1999, 33(7): 2023-2029.
32.	Philip M, Tessonier L, Mancini J, et al. Comparison between ESC and Duke criteria for the diagnosis of prosthetic valve infective endocarditis. JACC Cardiovasc Imaging, 2020, 13(12): 2605-2615.
33.	Papadimitriou-Olivgeris M, Monney P, Frank M, et al. Evaluation of the 2023 Duke-ISCVID and 2023 Duke-ESC clinical criteria for the diagnosis of infective endocarditis in a multicenter cohort of patients with Staphylococcus aureus Bacteremia. Clin Infect Dis, 2024, 78(3): 655-662.
34.	Moisset H, Rio J, Benhard J, et al. Evaluation of the specificity of the 2023 Duke-International Society of Cardiovascular Infectious Diseases classification for infective endocarditis. Clin Infect Dis, 2024, 78(4): 930-936.
35.	Spaleniak S, Lubas A, Kade G et al. Infective endocarditis in chronic hemodialysis patients is it still a growing clinical challenge? Polski merkuriusz lekarski: Organ Polskiego Towarzystwa Lekarskiego, 2019, 46(272): 64-67.
36.	Sadeghi M, Behdad S, Shahsanaei F. Infective endocarditis and its short and long-term prognosis in hemodialysis patients: a systematic review and meta-analysis. Curr Probl Cardiol, 2021, 46(3): 100680.
37.	Thornhill MH, Gibson TB, Yoon F, et al. Antibiotic prophylaxis against infective endocarditis before invasive dental procedures. J Am Coll Cardiol, 2022, 80(11): 1029-1041.

1. Dayer MJ, Quintero-Martinez JA, Thornhill MH, et al. Recent insights into native valve infective endocarditis: JACC Focus Seminar 4/4. J Am Coll Cardiol, 2024, 83(15): 1431-1443.
2. Cuervo G, Quintana E, Regueiro A, et al. The clinical challenge of prosthetic valve endocarditis: JACC Focus Seminar 3/4. J Am Coll Cardiol, 2024, 83(15): 1418-1430.
3. Habib G, Erba PA, Iung B, et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J, 2019, 40(39): 3222-3232.
4. AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, Pettersson GB, Coselli JS, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg, 2017, 153(6): 1241-1258.
5. de Leau MM, Kuipers RS. Cardiovascular complications of Streptococcus pneumoniae bacteraemia. BMJ Case Rep, 2021, 14(4): e240341.
6. Erdem H, Baymakova M, Alkan S, et al. Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study. Eur J Clin Microbiol Infect Dis, 2023, 42(4): 387-398.
7. Zmaili M, Alzubi J, Lo Presti Vega S, et al. Non-bacterial thrombotic endocarditis: a state-of-the-art contemporary review. Prog Cardiovasc Dis, 2022, 74: 99-110.
8. Venepally NR, Arsanjani R, Agasthi P, et al. A new insight into nonbacterial thrombotic endocarditis: a systematic review of cases. Anatol J Cardiol, 2022, 26(10): 743-749.
9. Alfatlawi H, Alharbi A, Shah M, et al. The impact of Libman-sacks endocarditis on inpatient outcomes with systemic lupus erythematosus: a retrospective study. Lupus, 2024, 33(7): 693-699.
10. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
11. Von Reyn CF, Levy BS, Arbeit RD, et al. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med, 1981, 94(4 pt 1): 505-518.
12. Pelletier LL Jr, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963-72. Medicine, 1977, 56(4): 287-313.
13. Tissières P, Gervaix A, Beghetti M, et al. Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children. Pediatrics, 2003, 112(6 Pt 1): e467.
14. Hoen B, Selton-Suty C, Danchin N, et al. Evaluation of the Duke criteria versus the Beth Israel criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 1995, 21(4): 905-909.
15. 錢杰, 高潤霖, 熊長明, 等. 感染性心內膜炎93例臨床分析及兩種國際診斷標準的比較. 中華心血管病雜志, 2003, 31(10): 27-30.Qian J, Gao RL, Xiong CM, et al. Clinical analysis of 93 cases of pathologically confirned infective endocarditis and comparisonbetween two international diagnostie criteria. Chin J Cardiol, 2003, 31(10): 27-30.
16. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med, 1994, 96(3): 200-209.
17. Stockheim JA, Chadwick EG, Kessler S, et al. Are the Duke criteria superior to the Beth Israel criteria for the diagnosis of infective endocarditis in children? Clin Infect Dis, 1998, 27(6): 1451-1456.
18. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 2000, 30(4): 633-638.
19. Hill EE, Herijgers P, Claus P, et al. Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study. Am Heart J, 2007, 154(5): 923-928.
20. 中華醫學會兒科學分會心血管學組, 中華兒科雜志編輯委員會. 小兒感染性心內膜炎的診斷標準 (試行). 中華兒科雜志, 2001, 39(5): 57.Group of Cardiology, Society of Pediatrics, Chinese Medical Association; Editorial Committee of Chinese Journal of Pediatrics. Diagnostic criteria for pediatric infective endocarditis (provisional). Chin J Pediatr, 2001, 39(5): 57.
21. 陳凡, 錢志勇, 彭志勇, 等. 感染性心內膜炎兩種診斷標準的比較研究. 中國現代醫學雜志. 2010, 20(1): 69-72.Chen F, Qian ZY, Peng ZY, et al. A comparative study of two diagnostic criteria for infective endocarditis. Chin J Mod Med, 2010, 20(1): 69-72.
22. 王國華, 吳弘, 秦永文, 等. 中國標準和Duke標準診斷感染性心內膜炎比較研究中國心血管病研究. 2007, 5(7): 481-484.Wang GH, Wu H, Qin YW, et al. Comparing the diagnostic value of the Chinese criteria and the Duke criteria for infective endocarditis in medical pract. Chin J Cardiovasc Rew, 2007, 5(7): 481-484.
23. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
24. Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified duke criteria. Clin Infect Dis, 2023, 77(4): 518-526.
25. Chen H, Yin Y, Gao H, et al. Clinical utility of in-house metagenomic next-generation sequencing for the diagnosis of lower respiratory tract infections and analysis of the host immune response. Clin Infect Dis, 2020, 71(Suppl 4): S416-S426.
26. Papadimitriou-Olivgeris M, Monney P, Frank M, et al. Evaluation of the 2023 Duke-International Society of Cardiovascular Infectious Diseases criteria in a multicenter cohort of patients with suspected infective endocarditis. Clin Infect Dis, 2024, 78(4): 949-955.
27. Lindberg H, Berge A, Jovanovic-Stjernqvist M, et al. Performance of the 2023 Duke-International Society of Cardiovascular Infectious Diseases diagnostic criteria for infective endocarditis in relation to the modified duke criteria and to clinical management-reanalysis of retrospective bacteremia cohorts. Clin Infect Dis, 2024, 78(4): 956-963.
28. Goehringer F, Lalloué B, Selton-Suty C, et al. Compared performance of the 2023 Duke-International Society for Cardiovascular Infectious Diseases, 2000 modified Duke, and 2015 European Society of Cardiology criteria for the diagnosis of infective endocarditis in a French multicenter prospective cohort. Clin Infect Dis, 2024, 78(4): 937-948.
29. van der Vaart TW, Bossuyt PMM, Durack DT, et al. External validation of the 2023 Duke-International Society for Cardiovascular Infectious Diseases diagnostic criteria for infective endocarditis. Clin Infect Dis, 2024, 78(4): 922-929.
30. Cecchi E, Parrini I, Chinaglia A, et al. New diagnostic criteria for infective endocarditis. A study of sensitivity and specificity. Eur Heart J, 1997, 18(7): 1149-1156.
31. Habib G, Derumeaux G, Avierinos JF, et al. Value and limitations of the Duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol, 1999, 33(7): 2023-2029.
32. Philip M, Tessonier L, Mancini J, et al. Comparison between ESC and Duke criteria for the diagnosis of prosthetic valve infective endocarditis. JACC Cardiovasc Imaging, 2020, 13(12): 2605-2615.
33. Papadimitriou-Olivgeris M, Monney P, Frank M, et al. Evaluation of the 2023 Duke-ISCVID and 2023 Duke-ESC clinical criteria for the diagnosis of infective endocarditis in a multicenter cohort of patients with Staphylococcus aureus Bacteremia. Clin Infect Dis, 2024, 78(3): 655-662.
34. Moisset H, Rio J, Benhard J, et al. Evaluation of the specificity of the 2023 Duke-International Society of Cardiovascular Infectious Diseases classification for infective endocarditis. Clin Infect Dis, 2024, 78(4): 930-936.
35. Spaleniak S, Lubas A, Kade G et al. Infective endocarditis in chronic hemodialysis patients is it still a growing clinical challenge? Polski merkuriusz lekarski: Organ Polskiego Towarzystwa Lekarskiego, 2019, 46(272): 64-67.
36. Sadeghi M, Behdad S, Shahsanaei F. Infective endocarditis and its short and long-term prognosis in hemodialysis patients: a systematic review and meta-analysis. Curr Probl Cardiol, 2021, 46(3): 100680.
37. Thornhill MH, Gibson TB, Yoon F, et al. Antibiotic prophylaxis against infective endocarditis before invasive dental procedures. J Am Coll Cardiol, 2022, 80(11): 1029-1041.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Evolution and interpretation of diagnostic criteria for infective endocarditis

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