Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study.
[en] 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.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Habib, Gilbert
Erba, Paola Anna
Iung, Bernard
Donal, Erwan
Cosyns, Bernard
Laroche, Cecile
Popescu, Bogdan A.
Prendergast, Bernard
Tornos, Pilar
Sadeghpour, Anita
Oliver, Leopold
Vaskelyte, Jolanta-Justina
Sow, Rouguiatou
Axler, Olivier
Maggioni, Aldo P.
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study.
Publication date :
2019
Journal title :
European Heart Journal
ISSN :
0195-668X
eISSN :
1522-9645
Publisher :
Oxford University Press, United Kingdom
Volume :
40
Issue :
39
Pages :
3222-3232
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG Jr, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: The International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009;169:463-473.
Habib G. Management of infective endocarditis. Heart 2006;92:124-130.
Chu VH, Cabell CH, Benjamin DK Jr, Kuniholm EF, Fowler VG Jr, Engemann J, Sexton DJ, Corey GR, Wang A. Early predictors of in-hospital death in infective endocarditis. Circulation 2004;109:1745-1749.
San Roman JA, Lopez J, Vilacosta I, Luaces M, Sarria C, Revilla A, Ronderos R, Stoermann W, Gomez I, Fernandez-Aviles F. Prognostic stratification of patients with left-sided endocarditis determined at admission. Am J Med 2007;120: 369-367.
Hoen B, Alla F, Selton SC, Beguinot I, Bouvet A, Briançon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Le Moing V, Leport C, Mainardi JL, Ruimy R, Vandenesch F. Association pour l'Etude et la Prevention de l'Endocardite Infectieuse (AEPEI) Study Group. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 2002;288:75-81.
Selton-Suty C, Celard M, Le Moing V, Doco-Lecompte T, Chirouze C, Iung B, Strady C, Revest M, Vandenesch F, Bouvet A, Delahaye F, Alla F, Duval X, Hoen B, Aepei SG. Pre-eminence of Staphylococcus aureus in infective endocarditis: A 1-year population-based survey. Clin Infect Dis 2012; 54:1230-1239.
Tornos P, Iung B, Permanyer-Miralda G, Baron G, Delahaye F, Gohlke-Barwolf C, Butchart EG, Ravaud P, Vahanian A. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart 2005;91:571-575.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL; ESC Scientific Document Group. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075-3128.
Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt J-U, Sicari R, Cosyns B, Fox K, Aakhus S; European Association of Echocardiography. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 2010;11:202-219.
Saby L, Laas O, Habib G, Cammilleri S, Mancini J, Tessonnier L, Casalta JP, Gouriet F, Riberi A, Avierinos JF, Collart F, Mundler O, Raoult D, Thuny F. Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis: increased valvular 18F-fluorodeoxyglucose uptake as a novel major criterion. J Am Coll Cardiol 2013;61:2374-2382.
Bruun NE, Habib G, Thuny F, Sogaard P. Cardiac imaging in infectious endocarditis. Eur Heart J 2014; 35:624-632.
Erba PA, Conti U, Lazzeri E, Sollini M, Doria R, De Tommasi SM, Bandera F, Tascini C, Menichetti F, Dierckx RA, Signore A, Mariani G. Added value of 99mTc-HMPAO-labeled leukocyte SPECT/CT in the characterization and management of patients with infectious endocarditis. J Nucl Med 2012;53:1235-1243.
Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, Casabe JH, Chu VH, Delahaye F, Edathodu J, Fortes CQ, Olaison L, Pangercic A, Patel M, Rudez I, Tamin SS, Vincelj J, Bayer AS, Wang A. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis 2013;56:209-217.
Bannay A, Hoen B, Duval X, Obadia J-F, Selton-Suty C, Le Moing V, Tattevin P, Iung B, Delahaye F, Alla F, Leport C, Beguinot I, Bouvet A, Briancon S, Bruneval P, Danchin N, Etienne J, Goulet V, Mainardi JL, Roudaut R, Ruimy R, Salamon R, Texier-Maugein J, Vandenesch F, Bernard Y, Duchene F, Plesiat P, Doco-Lecompte T, Selton-Suty C, Weber M, Beguinot I, Nazeyrollas P, Vernet V, Garin B, Lacassin F, Robert J, Andremont A, Garbaz E, Le Moing V, Leport C, Mainardi JL, Ruimy R, Chidiac C, Delahaye F, Etienne J, Vandenesch F, Boucherit S, Bourezane Y, Nouioua W, Renaud D, Bouvet A, Collobert G, Merad B, Schlegel L, Bes M, Etienne J, Vandenesch F. The impact of valve surgery on shortand long-Term mortality in left-sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? Eur Heart J 2011; 32:2003-2015.
Kang DH, Kim YJ, Kim SH, Sun BJ, Kim DH, Yun SC, Song JM, Choo SJ, Chung CH, Song JK, Lee JW, Sohn DW. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 2012;366:2466-2473.
Habib G, Lancellotti P, Erba PA, Sadeghpour A, Meshaal M, Sambola A, Furnaz S, Citro R, Ternacle J, Donal E, Cosyns B, Popescu B, Iung B, Prendergast B, Laroche C, Tornos P, Pazdernik M, Maggioni A, Gale CP; EURO-ENDO Investigators. The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Eur Heart J Qual Care Clin Outcomes 2019;5:202-207.
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245-1251.
May S, Hosmer DW. A simplified method of calculating an overall goodness-offit test for the Cox proportional hazards model. Lifetime Data Anal 1998;4:20.
Oliver L, Lavoute C, Giorgi R, Salaun E, Hubert S, Casalta JP, Gouriet F, Renard S, Saby L, Avierinos JF, Maysou LA, Riberi A, Grisoli D, Casalta AC, Collart F, Raoult D, Habib G. Infective endocarditis in octogenarians. Heart 2017;103: 1602-1609.
Pizzi M, Roque A, Fernandez-Hidalgo N, Cuellar-Calabria H, Ferreira-Gonzalez I, Gonzalez-Alujas MT, Oristrell G, Gracia Sanchez L, Gonzalez JJ, Rodr?guez-Palomares J, Galinanes M, Maisterra-Santos O, Garcia-Dorado D, Castell-Conesa J, Almirante B, Aguade-Bruix S, Tornos P. Improving the diagnosis of infective endocarditis in prosthetic valves and intracardiac devices with 18F-fluordeoxyglucose positron emission tomography/computed tomography angiography. Initial results at an infective endocarditis referral center. Circulation 2015;132: 1113-1126.
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633-638.
Di Salvo G, Habib G, Pergola V, Avierinos JF, Philip E, Casalta JP, Vailloud JM, Derumeaux G, Gouvernet J, Ambrosi P, Lambert M, Ferracci A, Raoult D, Luccioni R. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001;37:1069-1076.
Hubert S, Thuny F, Resseguier N, Giorgi R, Tribouilloy C, Le Dolley Y, Casalta JP, Riberi A, Chevalier F, Rusinaru D, Malaquin D, Remadi JP, Ammar AB, Avierinos JF, Collart F, Raoult D, Habib G. Prediction of symptomatic embolism in infective endocarditis: construction and validation of a risk calculator in a multicenter cohort. J Am Coll Cardiol 2013;62:1384-1392.
