Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study

Eur Heart J. 2019 Oct 14;40(39):3222-3232. doi: 10.1093/eurheartj/ehz620.

Abstract

Aims: The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE).

Methods and results: Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated.

Conclusion: Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

Keywords: Infective endocarditis; Registry; Valve disease.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Africa, Northern / epidemiology
  • Aged
  • Aged, 80 and over
  • Asia / epidemiology
  • Community-Acquired Infections / diagnostic imaging
  • Community-Acquired Infections / epidemiology
  • Echocardiography / statistics & numerical data
  • Embolism / microbiology*
  • Endocarditis, Bacterial / diagnostic imaging*
  • Endocarditis, Bacterial / epidemiology
  • Endocarditis, Bacterial / microbiology
  • Endocarditis, Bacterial / therapy*
  • Enterococcus
  • Europe / epidemiology
  • Female
  • Fluorodeoxyglucose F18
  • Heart Valve Prosthesis / adverse effects
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography / statistics & numerical data*
  • Prospective Studies
  • Prosthesis-Related Infections / diagnostic imaging
  • Prosthesis-Related Infections / epidemiology
  • Radiopharmaceuticals
  • Registries
  • South America / epidemiology
  • Staphylococcal Infections / complications
  • Streptococcal Infections / complications
  • Treatment Outcome

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18