Introduction
Infective endocarditis (IE) remains a significant global health concern, characterized by its high morbidity and mortality rates. Despite advancements in medical and surgical treatments, the landscape of IE continues to evolve, necessitating ongoing research and surveillance. The EURO-ENDO registry, a large-scale, prospective study across numerous European and non-European centers, provides crucial insights into the contemporary management and outcomes of adult patients diagnosed with infective endocarditis. This registry, adhering to the European Society of Cardiology (ESC) 2015 diagnostic criteria, offers a comprehensive overview of current clinical practices and patient profiles in the context of infective endocarditis within the Euro E area and beyond.
Study Design and Patient Population
The EURO-ENDO registry enrolled 3116 adult patients diagnosed with IE between January 2016 and March 2018. Participants were recruited from 156 hospitals spanning 40 countries, with a substantial European cohort of 2470 patients and an additional 646 patients from non-ESC affiliated countries. The study meticulously collected clinical, biological, microbiological, and advanced imaging data, including echocardiography, computed tomography (CT) scans, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). The cohort included patients with native valve endocarditis (NVE, 56.6%), prosthetic valve endocarditis (PVIE, 30.1%), and cardiac device-related infective endocarditis (CDRIE, 9.9%). A majority of cases were community-acquired (65.66%).
Microbiological Etiology and Imaging Modalities
Staphylococci were identified as the predominant causative microorganisms (44.1%), followed by enterococci (15.8%), oral streptococci (12.3%), and Streptococcus gallolyticus (6.6%). The study notably incorporated 18F-FDG PET/CT, performed in 16.6% of patients, revealing cardiac uptake in 42.9% of these cases. The sensitivity of 18F-FDG PET/CT varied across IE types, demonstrating higher sensitivity in PVIE (66.8%) compared to NVE (28.0%) and CDRIE (16.3%). This highlights the differential diagnostic utility of advanced imaging in various forms of infective endocarditis within the euro e region.
Clinical Manifestations and Surgical Interventions
Embolic events, a serious complication of IE, occurred in 20.6% of patients. These events were significantly associated with tricuspid or pulmonary valve involvement, the presence of vegetations, and Staphylococcus aureus infection. Cardiac surgery, a critical component of IE management, was indicated in 69.3% of patients based on ESC guidelines. However, surgical intervention was ultimately performed in 73.9% of those with guideline-based indications. This discrepancy underscores potential gaps in the implementation of recommended surgical strategies in real-world clinical practice across the euro e area and participating regions.
Mortality and Prognostic Factors
In-hospital mortality was observed in 17.1% of the overall cohort and was notably higher in patients with PVIE. Independent predictors of mortality identified in the EURO-ENDO registry included factors such as the Charlson comorbidity index, elevated creatinine levels (> 2 mg/dL), congestive heart failure, vegetation length exceeding 10 mm, cerebral complications, abscess formation, and the failure to perform indicated cardiac surgery. These findings emphasize the complex interplay of patient-specific factors and management strategies influencing outcomes in infective endocarditis within the euro e context.
Conclusion
The EURO-ENDO registry underscores that infective endocarditis remains a life-threatening condition with substantial mortality, even in the contemporary era of advanced diagnostics and therapeutics. The registry’s comprehensive data elucidates the evolving clinical, microbiological, imaging, and therapeutic profiles of IE patients across a broad geographical spectrum, predominantly within Europe. The identified predictors of mortality highlight critical areas for improved risk stratification and targeted interventions to enhance patient outcomes in this challenging disease. The insights from this euro e focused registry are crucial for guiding future clinical practice and research endeavors in the field of infective endocarditis.
