External Validation of the 2023 Duke - International Society for Cardiovascular Infectious Diseases Diagnostic Criteria for Infective Endocarditis.

INTRODUCTION: The 2023 Duke-International Society of Cardiovascular Infectious Diseases (ISCVID) Criteria for IE were introduced to improve classification of infective endocarditis (IE) for research and clinical purposes. External validation studies are required.

METHODS: We studied consecutive patients with suspected IE referred to the IE Team of Amsterdam University Medical Center (October 2016-March 2021). An international expert panel independently reviewed case summaries, and assigned a final diagnosis of "IE" or "Not IE" , which served as the reference standard, to which the "Definite" Duke-ISCVID classifications were compared. We also evaluated accuracy when excluding cardiac surgery and pathology data ("Clinical Criteria"). Lastly, we compared the 2023 Duke-ISCVID to the 2000 Modified Duke Criteria and the 2015 and 2023 European Society of Cardiology (ESC) Criteria.

RESULTS: 595 consecutive patients with suspected IE were included: 399 (67%) were adjudicated as IE; 111 (19%) had prosthetic valve IE and 48 (8%) had cardiac implantable electronic device IE. The 2023 Duke-ISCVID Criteria were more sensitive than either the Modified Duke or 2015 ESC Criteria (84.2% vs 74.9% and 80% respectively, p < 0.001) without significant loss of specificity. The 2023 Duke-ISCVID Criteria were similarly sensitive but more specific than the 2023 ESC Criteria (94% vs 82%, p <0.001). The same pattern was seen for the Clinical Criteria (excluding surgery/pathology results). New modifications in the 2023 Duke-ISCVID Criteria related to 'Major Microbiological' and 'Imaging' criteria were most impactful.

CONCLUSION: The 2023 Duke-ISCVID Criteria represent a significant advance in the diagnostic classification of patients with suspected IE.