Infective endocarditis (IE) remains a significant global health concern, characterized by its life-threatening nature despite advancements in medical care. The EURO-ENDO registry, a comprehensive, multi-national study, provides critical insights into the contemporary management and outcomes of this complex condition. This analysis, derived from the EURO-ENDO registry, highlights key findings relevant to clinicians and researchers in the field of cardiology and infectious diseases.
The EURO-ENDO registry was a prospective cohort study that enrolled 3116 adult patients diagnosed with IE across 156 hospitals in 40 countries between January 2016 and March 2018. The diagnosis adhered to the European Society of Cardiology (ESC) 2015 criteria. Data collected encompassed a broad spectrum of clinical, biological, microbiological, and advanced imaging modalities, including echocardiography, computed tomography (CT) scans, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). This extensive data collection allows for a detailed understanding of IE presentation and management in a contemporary setting.
Key demographic and etiological findings from the EURO-ENDO registry reveal that native valve endocarditis (NVE) was the most common presentation, accounting for 56.6% of cases, followed by prosthetic valve endocarditis (PVIE) at 30.1%, and cardiac device-related infective endocarditis (CDRIE) at 9.9%. A majority of cases, 65.66%, were community-acquired. Microbiological analysis identified staphylococci as the predominant causative agents (44.1%), followed by enterococci (15.8%), oral streptococci (12.3%), and Streptococcus gallolyticus (6.6%). These findings underscore the diverse microbial landscape of IE and the importance of prompt and accurate microbiological diagnosis.
Advanced imaging with 18F-FDG PET/CT was utilized in 16.6% of patients in the EURO-ENDO registry. Notably, cardiac uptake on PET/CT, a major diagnostic criterion, was observed in 42.9% of those imaged. The sensitivity of PET/CT varied significantly 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 PET/CT in various forms of endocarditis and its potential to improve diagnostic accuracy, particularly in PVIE.
Embolic events, a serious complication of IE, occurred in 20.6% of patients within the EURO-ENDO cohort. Several factors were significantly associated with embolic risk, including tricuspid or pulmonary valve involvement, the presence of vegetations, and Staphylococcus aureus etiology. These findings emphasize the importance of risk stratification for embolic events in IE patients to guide preventative strategies and clinical management.
Cardiac surgery is a cornerstone of IE treatment in selected patients. According to ESC guidelines, surgical intervention was indicated in a substantial proportion of patients in the EURO-ENDO registry (69.3%). However, surgery was ultimately performed in only 73.9% of those with an indication. This discrepancy suggests potential barriers to surgical access or decision-making complexities in real-world IE management.
Despite advancements in medical and surgical therapies, in-hospital mortality remained significant at 17.1% in the EURO-ENDO registry, with higher mortality observed in PVIE. Independent predictors of mortality identified in the study included pre-existing comorbidities (Charlson index), renal dysfunction (creatinine > 2 mg/dL), congestive heart failure, large vegetation size (> 10 mm), cerebral complications, abscess formation, and the failure to perform surgery when indicated. These predictors underscore the multifactorial nature of adverse outcomes in IE and highlight areas for targeted interventions to improve patient survival.
In conclusion, the EURO-ENDO registry provides a valuable contemporary snapshot of infective endocarditis. The results underscore that IE remains a severe and life-threatening condition with substantial morbidity and mortality. The registry’s findings emphasize the ongoing need for improved diagnostic strategies, optimized surgical decision-making, and targeted interventions to mitigate risk factors and enhance outcomes for patients with infective endocarditis globally. Further research building upon the EURO-ENDO registry is crucial to continue to advance the management of this challenging disease.
