Comparison between Duke, ESC-2015, ISCVID-2023 and ESC-2023 criteria for the diagnosis of TAVR-related infective endocarditis

Background: Transcatheter aortic valve replacement-related infective endocarditis (TAVR-IE) is associated with a poor prognosis. TAVR-IE diagnosis is challenging, and benefits of the most recent classifications (ESC-2015, ISCVID-2023 and ESC-2023) have not been compared with the conventional Duke criteria on this population.

Objectives: The primary objective was to compare the diagnostic value of the Duke, ESC-2015, ISCVID-2023, and ESC-2023 criteria for the diagnosis of TAVR-IE.The secondary objectives were to determine which criteria increase the diagnostic accuracy of each classification and to evaluate in-hospital and 1-year mortality of TAVR-IE.

Methods: From January 2015 to May 2022, 92 patients with suspected TAVR-IE were retrospectively included in 2 French centers, including 82 patients with definite TAVR-IE and 10 patients with rejected TAVR-IE as defined by expert consensus.

Results: Duke classification yielded a sensitivity of 65% (95%, CI: 53%-75%) and a specificity of 100% (95%, CI: 69%-100%) for the diagnosis of TAVR-IE. ESC-2015 classification increased Duke criteria sensitivity from 65% to 73% (p=0.016) but decreased specificity from 100% to 90%. ISCVID-2023 and ESC-2023 also increased Duke criteria sensitivity, from 65% to 76% (p=0.004) and 77% (p=0.002), respectively but also decreased specificity from 100% to 90%. A positive 18F-FDG PET/CT was the most helpful criterion, as 10 patients (11%) were correctly reclassified. In-hospital mortality after TAVR-IE was 21% and one-year mortality was 38%.

Conclusions: A multimodality imaging approach, including 18F-FDG PET/CT and gated cardiac CT, is the cornerstone of TAVR-IE diagnosis and explains the higher sensitivity of ESC-2015 and recent classifications compared with Duke criteria.