Euro e: Understanding and Managing Infective Endocarditis

Infective endocarditis (IE) remains a serious and potentially life-threatening condition. The EURO-ENDO registry, a multinational study involving 3116 adults across 40 countries, provides valuable insights into the contemporary management and outcomes of IE. The study encompassed a diverse patient population, including native valve endocarditis (NVE), prosthetic valve endocarditis (PVIE), and cardiac device-related endocarditis (CDRIE). Staphylococci, oral streptococci, and enterococci were the most common causative microorganisms.

The EURO-ENDO registry highlighted the significant role of advanced imaging techniques in diagnosing IE. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) demonstrated higher sensitivity in detecting PVIE compared to NVE and CDRIE. This underscores the importance of tailoring diagnostic approaches based on the specific type of IE. Embolic events, a serious complication of IE, were observed in a significant proportion of patients and were associated with factors like tricuspid or pulmonary valve involvement, vegetation presence, and Staphylococcus aureus infection.

Treatment decisions for IE often involve complex considerations. While cardiac surgery was recommended for a substantial portion of patients based on established guidelines, not all underwent the procedure. The study identified several independent predictors of in-hospital mortality, including pre-existing conditions, kidney function impairment, heart failure, vegetation size, neurological complications, abscess formation, and importantly, the failure to perform indicated surgery. This emphasizes the critical need for timely and appropriate interventions to improve patient outcomes. The findings from the EURO-ENDO registry reinforce that IE continues to pose a significant challenge, despite advancements in diagnostic and therapeutic strategies. Ongoing research and collaborative efforts are essential to further refine our understanding and management of this complex disease. Further studies focusing on specific subpopulations, such as those with PVIE or CDRIE, could provide valuable insights for tailored treatment strategies. Additionally, research exploring novel diagnostic and therapeutic approaches is warranted to improve outcomes for patients with this challenging condition. The high mortality rate associated with IE underscores the need for continued vigilance and prompt management of this serious infection.