Are the Duke criteria really useful for the early bedside diagnosis of infective endocarditis? Results of a prospective multicenter trial.

BACKGROUND: To date, no studies have evaluated the usefulness of the Duke vs the modified Duke criteria for the early diagnosis of infective endocarditis (IE), nor is it known whether a probabilistic approach may be useful in establishing an early clinical diagnosis of IE. The aim of this study was (1) to assess and compare the clinical usefulness of the Duke vs the modified Duke criteria for the early diagnosis of IE, and (2) to evaluate the diagnostic utility of a probabilistic approach based on the echocardiographic criterion. METHODS: From January 2000 to December 2001, 267 consecutive patients with suspected IE were enrolled in a prospective multicenter trial. RESULTS: IE was diagnosed in 147 cases (55%) and rejected in 120 cases (45%). The Duke and the modified Duke criteria had a high similar sensitivity, specificity and accuracy. The time to diagnosis was 8.15 +/- 7.4 days for the Duke criteria and 8.18 +/- 7.1 days for the modified Duke criteria. The time to diagnosis based on a probabilistic approach was shorter than that based on the Duke and the modified Duke criteria (4.96 +/- 7.1 days, for all p < 0.001). CONCLUSIONS: Although the Duke and the modified Duke criteria have a very similar sensitivity, specificity and accuracy, the delay in the time to diagnosis may be significant. A probabilistic approach based on clinical suspicion and echocardiographic evidence may be useful for decision-making, whilst awaiting case definition by means of the Duke criteria.

Main pulmonary artery aneurysm: a case report and review of the literature.

Main pulmonary artery aneurysms are a rare entity with few available published data. As reported in the literature, operative treatment is commonly recommended but the relation between the size of the aneurysm, its localization, and the risk of rupture is not as well defined as for aortic aneurysms. Proximal lesions that involve the main branches of the pulmonary artery are usually apparent on chest radiographs and must be taken into consideration in the differential diagnosis of mediastinal masses. An early diagnosis allows timely surgical treatment. We report an unusual case of a main pulmonary artery aneurysm presenting with persistent non-productive cough and provide a review of the pertinent published data.

Brugada syndrome: a case report of an unusual association with vasospastic angina and coronary myocardial bridging.

This report describes a case of an unusual association between vasospastic angina, coronary myocardial bridging, and Brugada syndrome. The patient complained of chest pain followed by rhythmic palpitation and syncope. Brugada syndrome ECG markers were documented with transient ST-segment elevation in lateral leads. A coronary angiogram showed a myocardial bridging in the left anterior descending artery and coronary vasospasm was reproduced after intracoronary ergonovine injection in the circumflex coronary artery. Ventricular fibrillation was induced by programmed electrical stimulation. The described association can be important because interaction between ischemia and Brugada syndrome electrophysiological substrate could modulate individual susceptibility to life-threatening ventricular tachyarrhythmias.