Editor’s Note: In the dynamic field of infectious diseases, guidelines must adapt to reflect ongoing research and technological advancements to ensure the highest standards of patient care. The 2023 European Society of Cardiology (ESC) Guidelines for the diagnosis of endocarditis mark a significant advancement in how clinicians approach this complex disease. To gain deeper insights into these important changes, Infectious Disease Frontier interviewed Dr. Maria Nazarena Pizzi, a leading cardiologist and expert in cardiac imaging at Vall d’Hebron University Hospital in Barcelona, Spain. Dr. Pizzi, with her extensive involvement in the development of these guidelines, shares her valuable perspective on their implications for clinical practice.
Infectious Disease Frontier: We appreciate you joining us today. Could you begin by introducing yourself to our audience in China?
Dr. Pizzi: Thank you for inviting me. I am a cardiologist with a specialization in cardiac imaging, I work at Vall d’Hebron University Hospital in Barcelona. Our team at the hospital has a particular focus on endocarditis, and I have had the privilege to be involved in both, the updates of the 2023 European Society of Cardiology (ESC) guidelines related to this disease and the 2023 updated Duke Criteria. My role primarily revolves around integrating new diagnostic techniques and improving clinical pathways for better disease management.
Infectious Disease Frontier: Could you please elaborate on the new changes or updates in the diagnostic process outlined in the 2023 ESC Endocarditis Guidelines? How do these modifications specifically impact or serve as guidance for clinicians in their daily practice?
Dr. Pizzi: The latest guidelines are an evolution of the 2015 recommendations. We have incorporated a comprehensive multi-modality imaging approach, which includes advanced techniques such as CT, nuclear medicine like PET-CT and SPECT-CT, white blood cell imaging, MRI, and even brain CT scans. We’ve meticulously organized the diagnostic process with specific algorithms tailored for different scenarios—native valves, prosthetic valves, and cardiac device infections. These algorithms are designed to streamline the diagnostic pathway and provide clear, structured guidance to clinicians. Additionally, in our supplementary materials, we offer extensive tips on interpreting these complex imaging results, aiming to enhance diagnostic accuracy and facilitate educational growth among medical professionals.
Infectious Disease Frontier: The updated guidelines place a strong emphasis on the significance of imaging techniques, particularly in the diagnosis of blood culture-negative infective endocarditis (BCNIE). Could you discuss the value of various imaging modalities in the diagnosis of infective endocarditis (IE)?
Dr. Pizzi: Diagnosing BCNIE is notably challenging because it often lacks microbial criteria, which are crucial for a definitive diagnosis. Traditionally, major criteria would include microbial evidence, but with negative cultures, we lean heavily on imaging. The guideline categorizes findings from different imaging techniques under a single major criterion, which emphasizes the importance of each modality. For instance, echocardiography, CT, and PET scans play pivotal roles. These technologies are not just supplementary; in many cases, they are decisive, especially when prior antibiotic treatment has negated culture effectiveness. This reliance underscores the need for ongoing improvements and adaptations in imaging technology to better support clinical diagnoses.
Infectious Disease Frontier: What is your opinion on the utility of molecular detection techniques such as mNGS and 16S rRNA in the diagnosis of IE?
Dr. Pizzi: While imaging is my primary field, the importance of molecular techniques is paramount. These methods, which focus on detecting genetic material of pathogens, represent a significant advancement in microbiological diagnosis. They provide an alternative pathway to identify causative agents, especially when traditional cultures fail. As we continue to integrate and support new technologies in imaging, similar enhancements in molecular diagnostics are crucial for a holistic diagnostic approach.
Infectious Disease Frontier: The new guidelines also highlight the increasing incidence of cardiovascular implantable electronic devices (CIED)-related IE. What key considerations do you believe should be taken into account when diagnosing such infections?
Dr. Pizzi: Cardiac device infections are indeed a growing concern and are somewhat distinct from traditional endocarditis, though they are discussed within the same guidelines. Our approach includes specific recommendations for using new technologies like PET/CT to detect infections in parts of the device, such as the generator or the pocket. However, we acknowledge the limited evidence for detecting infections in the leads. Thus, while we have made significant strides in this area, further research and evidence are needed to refine these diagnostic techniques. It’s crucial that we continue to adapt our guidelines as new evidence emerges, ensuring that our recommendations reflect the best possible practices.
