Tiếp cận mới trong chẩn đoán viêm nội tâm mạc nhiễm khuẩn - Nguyễn Thị Thu Hoài

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