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SIRWe read with interest the report by Hoen et al. [1], in which the sensitivity of the Duke criteria was compared with that of the Beth Israel criteria for the diagnosis of infective endocarditis (IE); the authors retrospectively analyzed the data for 115 consecutive patients with suspected IE. They found that the percentage of patients classified as having "clinically definite" IE by the Duke criteria was higher than the percentage of those classified as having "probable" IE by the Beth Israel criteria; these results correspond with those obtained by Bayer et al. [2]. Our group recently compared both sets of diagnostic criteria for a series of 113 consecutive patients seen over a period of 9 years (1986-1994) at Malaga Regional Hospital (Malaga, Spain) and obtained similar results (unpublished observation). In a second analysis, we compared the sensitivity of the Duke criteria to that of a modification (the addition of echocardiographic findings) of the Beth Israel criteria. By simply giving the same qualitative weight for the diagnosis of IE to a positive echocardiogram (i.e., evidence of a vegetation, abscess, or new partial dehiscence of a prosthetic valve) as that given to the detection of a new regurgitant murmur, the sensitivity of the Beth Israel criteria was significantly improved and almost equaled that of the Duke criteria (table 1). That the Duke criteria were more sensitive than were the original Beth Israel criteria is to be expected, since the original Beth Israel criteria do not take into account echocardiographic findings. In the last 10 years, most of the reported series of IE have been based on the modified Beth Israel criteria. These modified criteria, as shown above, are almost as sensitive as the recently proposed Duke criteria, and they lack only standardization. The Beth Israel diagnostic categories have a rational basis and take into account

Comparable Sensitivity of the Duke Criteria and the Modified Beth Israel Criteria for Diagnosing Infective Endocarditis