Diagnostic performance of 2023 endocarditis criteria in patients with and without cardiac implantable electronic devices
Authors' conclusion
The 2023 ESC and 2023 Duke-ISCVID classifications had a higher sensitivity but a lower specificity than the 2015 ESC classification in patients with CIEDs, especially among those with lead IE. In patients with CIEDs, the 2019 EHRA classification was the most accurate.
Study context
- Population
- Patients treated for infective endocarditis (IE) between January 2017 and October 2022, with or without cardiac implantable electronic devices (CIEDs)patients treated for IE · patients with CIEDs 269 · patients with CIEDs and lead IE 159 · patients without CIEDs 911
- Participants
- 1,180 patients
- Exposure
- We compared the performance of the 2023 European Society of Cardiology (ESC) classification to that of 2015 ESC, 2019 European Heart Rhythm Association (EHRA) and 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) classifications; gold standard: expert-adjudicated 'certain' IE
- Outcome
- Sensitivity and specificity in patients with CIEDs
Main finding
As reported in the abstract
| Group | Sensitivity | Specificity |
|---|---|---|
| 2023 Duke-ISCVID | 97.1% | 31.1% |
| 2023 ESC | 93.8% | 41.0% |
Sensitivity
2023 Duke-ISCVID97.1%
2023 ESC93.8%
Specificity
2023 Duke-ISCVID31.1%
2023 ESC41.0%
- Adjudicated as 'certain IE' (of the 269 patients with CIEDs)
- 208 (77.3%)
Observational data: associations, not effects.
Further findings
Specificity
| Outcome | 2023 ESC | 2015 ESC | 2019 EHRA | 2023 Duke-ISCVID | |
|---|---|---|---|---|---|
| Specificity in patients with CIEDs and lead IE | 32.4% | Not reported in the abstract | 67.6% | 11.8% | 2015 ESC: not reported in the abstract |
| Sensitivity and specificity in patients without CIEDs | 48.0% | 55.5% | Not reported in the abstract | 52.6% | 2019 EHRA: not reported in the abstract |
- Specificity in patients with CIEDs and lead IE — 'certain IE' among the 159 patients with CIEDs and lead IE
- 78.6%
- Sensitivity and specificity in patients without CIEDs — 'certain IE' among the 911 patients without CIEDs
- 81.0%
- Sensitivity and specificity in patients without CIEDs — Sensitivity for all classifications
- higher than 96%
Specificity in patients with CIEDs and lead IE
- Sensitivity remained high for all classifications
Original publication
Diagnostic performance of 2023 endocarditis criteria in patients with and without cardiac implantable electronic devices. Heart. Published 11 November 2025. doi:10.
Summarised from the published abstract; every number is checked against it