Hội nghị Tim mạch Toàn quốc - Hà nội - 10/2016 Vietnam National Heart Association Congress of Cardiology 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 Introduction • Infective endocarditis (IE): serious cause of cardiac infection • Poor prognosis and mortality • The incidence: - 10/ 100 000/year, increase with age • Survival rates can be improved with an early and accurate diagnosis of infection and its complications BMJ 2016 Diagnostic guidelines and criteria • Von Reyn Criteria (1981) • Initial Duke Criteria (1994) • Modified Duke Criteria (2000) • European Society of Cardiology (ESC) 2015 modified criteria Diagnostic guidelines and criteria • Von Reyn Criteria (1981) • Initial Duke Criteria (1994) • Modified Duke Criteria (2000) • European Society of Cardiology (ESC) 2015 modified criteria 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 Modified Duke criteria Modified Duke criteria Diagnostic guidelines and criteria Reasons of negative, inconclusive or false-positive echocardiographical findings in cases of infective endocarditis MOLECULAR DIAGNOSTICS Advantages and disadvantages of using molecular methods POSITRON-EMISSION TOMOGRAPHY Van nhân tạo Thiết bị cấy ghép điện tử Tắc mạch Các ổ nhiễm khuẩn di bệnh Advantages and limitations of 18F-FDG-PET/CT Advantages and limitations of 18F-FDG-PET/CT 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 Prosthetic valve endocarditis 13-31%: negative blood culture 30%: echocardiography are inconclusive Employment of cardiac imaging 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 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 Diagnostic guidelines and criteria 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 THANK YOU VERY MUCH! ... molecular methods POSITRON-EMISSION TOMOGRAPHY Van nhân tạo Thiết bị cấy ghép điện tử Tắc mạch Các ổ nhiễm khuẩn di bệnh Advantages and limitations of 18F-FDG-PET/CT Advantages and limitations of... modified criteria Limitations of current diagnostic approaches In some cases, where there is a strong clinical suspicion of IE, microbiological blood culture remains negative Cause: Antimicrobial... rates can be improved with an early and accurate diagnosis of infection and its complications BMJ 2016 Diagnostic guidelines and criteria • Von Reyn Criteria (1981) • Initial Duke Criteria (1994)