Diagnostic Performance Of Prosthetic Heart Valve Infective Endocarditis: A Comparison Of Diagnostic Modalities And Proposed Algorithm.

Abstract

Prosthetic valve endocarditis (PVE) is a potentially life-threatening complication following valve replacement surgery, with an increasing incidence due to the rise in prosthetic valve procedures. Accurate and timely diagnosis of PVE remains challenging due to altered cardiac anatomy and imaging artifacts. Traditional diagnostic tools, such as Duke criteria, were originally developed for native valve endocarditis and demonstrate suboptimal sensitivity and specificity in the context of PVE. Recent advancements incorporated novel molecular and imaging modalities, such as polymerase chain reaction and nuclear imaging techniques, in an attempt to improve the diagnostic accuracy. However, no single modality currently serves as a definitive gold standard. In conclusion, in this review, we critically compare the diagnostic performance of available tools for PVE, analyzing their sensitivity, specificity, positive predictive value, and negative predictive value. We further propose a practice approach to facilitate early and accurate diagnosis, ultimately aiming to improve clinical outcomes in patients with suspected PVE.