Ts Nguyễn Thị Thu Hoài

1. TIẾP CẬN MỚI TRONG CHẨN ĐOÁN
VIÊM NỘI TÂM MẠC NHIỄM KHUẨN
2016
Multi-modality approaches in diagnosis of
infective endocarditis 2016
TS. NGUYỄN THỊ THU HOÀI
VIỆN TIM MẠCH QUỐC GIA VIỆT NAM
Hội nghị Tim mạch Toàn quốc - Hà nội - 10/2016
Vietnam National Heart Association Congress of Cardiology

2. Introduction
BMJ 2016
• Infective endocarditis (IE): serious cause of cardiac
infection.
• Poor prognosis and mortality.
• The incidence: 3 - 10/ 100 000/year, increase with age.
• Survival rates can be improved with an early and accurate
diagnosis of infection and its complications.

3. Diagnostic guidelines and criteria
• Von Reyn Criteria (1981)
• Initial Duke Criteria (1994)
• Modified Duke Criteria (2000)
• European Society of Cardiology (ESC) 2015 modified
criteria

4. Diagnostic guidelines and criteria
• Von Reyn Criteria (1981)
• Initial Duke Criteria (1994)
• Modified Duke Criteria (2000)
• European Society of Cardiology (ESC) 2015 modified
criteria

5. Limitations of current diagnostic
approaches
In some cases, where there is a strong clinical suspicion
of IE, microbiological blood culture remains negative.
Cause: Antimicrobial therapy prior to blood cultures
being taken

6. Modified Duke criteria

7. Modified Duke criteria

8. Diagnostic guidelines and criteria

9. Reasons of negative, inconclusive or false-positive
echocardiographical findings in cases of infective endocarditis

10. MOLECULAR DIAGNOSTICS

11. Advantages and disadvantages of using molecular methods

12. Advantages and disadvantages of using molecular methods

13. POSITRON-EMISSION TOMOGRAPHY
Van nhân tạo
Thiết bị cấy ghép điện tử
Tắc mạch
Các ổ nhiễm khuẩn di bệnh

14. Advantages and limitations of 18F-FDG-PET/CT

15. Advantages and limitations of 18F-FDG-PET/CT

16. POSITRON-EMISSION TOMOGRAPHY
18F-FDG-PET/CT in a
patient with bioprosthetic
aortic valve infective
endocarditis. (a) Uptake
on the bioprosthesis
(white arrows). (b) Partly
thrombosed abdominal
aortic aneurysm with
uptake on the superior
mesenteric artery (white
arrow). Prosthetic
endocarditis complicated
by a mycotic aneurysm of
the superior mesenteric
artery was subsequently
confirmed.

17. 13-31%: negative blood culture
30%: echocardiography are inconclusive
Prosthetic valve endocarditis

18. Employment of cardiac imaging

19. A EUROPEAN PERSPECTIVE: IS IT TIME TO REFINE
DIAGNOSTIC CRITERIA FOR IE?
- Diagnosis of IE: difficult in clinical practice.
- Echocardiography and blood cultures are the cornerstone of
diagnosis: may be falsely negative in some situations,
particularly previous antibiotic therapy, and in patients with
prosthetic valve or other intracardiac material.

20. A EUROPEAN PERSPECTIVE: IS IT TIME TO REFINE
DIAGNOSTIC CRITERIA FOR IE?
- Published ESC guidelines recommend the use of Modified
Duke Criteria for the diagnosis of IE. It can be improved by
using new microbiological diagnostic techniques and new
imaging modalities (MRI, CT, PET/CT and SPECT/ CT).
- The latter nuclear imaging modalities are particularly helpful
when echocardiographic studies are doubtful and may
represent additional diagnostic criteria for IE.
- The 2015 ESC guidelines have specifically defined when
such imaging modalities should be used to aid in the diagnosis
of IE

24. Diagnostic guidelines and criteria

25. CONCLUSIONS
- Conventional diagnostic approaches such as microbiological
culture, serology and echocardiography are successful in aiding
in the diagnosis of the majority of cases of IE.
- When these methods are inconclusive, yet there is a strong
clinical suspicion of IE and related infection, it is important to
acknowledge the role molecular and 18F-FDG-PET/CT
approaches may play in aiding in the diagnosis and management
of these complicated cases.

26. THANK YOU VERY MUCH!