Objectives and characteristics of the study
These publications represent the main goals of the European Endocarditis registry (EURO-ENDO): to describe the current diagnostic and management practices in IE in Europe and beyond, and to evaluate its outcome depending on the correct implementation and adherence to the 2009 ESC guidelines on IE.
Why study infective endocarditis?
Infective endocarditis (IE) is a severe disease, associated with high morbidity and in-hospital mortality. Despite improvements in diagnostic and therapeutic strategies, both the incidence and severity of the disease seem to be unchanged.
Reasons for this persistent poor prognosis are numerous and include older patients with more severe disease, changes in the epidemiologic profiles and more patients with prosthetic or device related IE (8-10).
- The epidemiological profile of IE has changed during the past years, with important differences between countries and increasing numbers of staphylococcal and nosocomial endocarditis cases (1, 8). The European Society of Cardiology (ESC) Euro Heart Survey programme dedicated to valvular heart disease performed in 2001 already provided some useful information regarding the management of IE across Europe at that time (11). Hitherto, no attempt has been made to update and implement the results of the Euro Heart Survey in the contemporary era. There is, thus, a need for a comprehensive and dedicated IE survey.
- New diagnostic and therapeutic strategies have been developed in order to improve the diagnosis and the prognosis of the disease. The Guidelines on the prevention, diagnosis, and treatment of IE of the ESC were published in 2009 and gave new insight into both the diagnostic and therapeutic management of these patients (12). However, how these recommendations are implemented in real world clinical practice has never been studied.
- Although echocardiography is the first and recommended diagnostic method in IE (13), other non-invasive imaging techniques have received increasing attention, including multislice computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging (PET-CT) (14-19). However, their availability and use in different countries are unknown.
- Finally, although early surgery is recommended in patients with complicated IE, its impact on prognosis is still debated (20-26). With the present IE registry, it will be possible to assess whether both the implementation of guidelines published in 2009 and the use of early surgery are associated with a reduction in in-hospital and 1-year mortality. Therefore, this registry will give us the unique opportunity to assess the characteristics of IE in Europe, the current use of imaging techniques, as well as the correct implementation of the ESC guidelines and its consequence in terms of prognosis. All this will help improve the diagnosis and management of IE in Europe.
Study design and methods
The EURO-ENDO registry is a prospective multicentre observational study of patients presenting in the echocardiographic or imaging laboratories for definite IE and treated and followed by European centres. Diagnostic methods, type of medical therapy, indications for surgery, and mode of follow-up will be obtained according to the usual practice of the participating centres.
The Executive committee is chaired by Prof. Gilbert Habib (EACVI) and co-chaired by Prof. Patrizio Lancellotti (EACVI).
Executive Committee members
- Gilbert Habib, Chair, EACVI
- Patrizio Lancellotti, Co-Chair, EACVI and ESC WG VHD
- Erwan Donal, Executive Committee, EACVI
- Bernard Cosyns, Executive Committee, EACVI
- Bogdan A. Popescu, Executive Committee, EACVI
- Bernard Iung, ESC WG VHD
- Raphael Rosenhek, ESC WG VHD
- Bernard Prendergast, ESC WG VHD
- Pilar Tornos, ESC WG VHD
- Paola Erba, Nuclear Medicine, EACVI
- Aldo P Maggioni, Scientific Coordinator EORP, ex-officio (non-voting)
The Steering Committee is composed by the chairmen of the study and by the National Coordinator of each participating country selected by the EACVI in collaboration with the National Imaging Communities.
- Wang A, Athan E, Pappas PA, Fowler VG, Jr., Olaison L, Pare C, Almirante B, Munoz P, Rizzi M, Naber C, Logar M, Tattevin P, Iarussi DL, Selton-Suty C, Jones SB, Casabe J, Morris A, Corey GR, Cabell CH. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 2007;297(12):1354-1361.
- Habib G. Management of infective endocarditis. Heart 2006;92(1):124-130.
- Heiro M, Helenius H, Hurme S, Savunen T, Metsarinne K, Engblom E, Nikoskelainen J, Kotilainen P. Long-term outcome of infective endocarditis: a study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years. BMC Infect Dis 2008;8:49.
- Correa de Sa DD, Tleyjeh IM, Anavekar NS et al. Epidemiological trends of infective endocarditis : a population-based study in Olmsted County, Minnoseta. May Clin Proc 2010; 85: 422-426.
- Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG, Jr., Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falco V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH. 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(5):463-473.
- 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(14):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(4):369-7.
- Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endocarditis: results of a 1-year survey in France. Jama 2002;288:75-81.
- Cabell CH, Jollis JG, Peterson GE, et al. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002; 162: 90-4.
- Lopez J, Revilla A, Vilacosta I, et al. Age-dependent profile of left-sided infective endocarditis: a 3-center experience. Circulation 2010;121:892-7.
- 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(5):571-575.
- Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009;30:2369-413.
Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 2010;11(2):202-219.
- Saby L, Laas O, Habib G, et al. 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;61:2374-82.
- Bruun NE, Habib G, Thuny F, et al. Cardiac imaging in infectious endocarditis. Eur Heart J. 2014;35:624-32.
Sarrazin JF, Philippon F, Tessier M, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol 2012;59:1616-25.
- Hyafil F, Rouzet F, Lepage L, Benali K, Raffoul R, Duval X, Hvass U, Iung B, Nataf P, Lebtahi R, Vahanian A, Le Guludec D. Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography. Eur Heart J Cardiovasc Imaging 2013;14(6):586-594.
- 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(8):1235-1243.
- Rouzet F, Chequer R, Benali K, Lepage L, Ghodbane W, Duval X, Iung B, Vahanian A, Le Guludec D, Hyafil F. Respective performance of 18F-FDG PET and radiolabeled leukocyte scintigraphy for the diagnosis of prosthetic valve endocarditis. J Nucl Med 2014;55(12):1980-1985.
- Thuny F, Beurtheret S, Gariboldi V, et al. Outcome after surgical treatment performed within the first week of antimicrobial therapy during infective endocarditis: A prospective study. Arch Cardiovasc Dis 2008;101:687-95.
- Tleyjeh IM, Steckelberg JM, Georgescu G, Ghomrawi HM, Hoskin TL, Enders FB, Mookadam F, Huskins WC, Wilson WR, Baddour LM. The association between the timing of valve surgery and 6-month mortality in left-sided infective endocarditis. Heart 2008;94(7):892-896.
- 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(2):209-217.
- Bannay A, Hoen B, Duval X, Obadia JF, Selton-Suty C, Le M, V, Tattevin P, Iung B, Delahaye F, Alla F. The impact of valve surgery on short- and long-term mortality in left-sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? Eur Heart J 2011;32(16):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(26):2466-2473.
- Tleyjeh IM, Ghomrawi HM, Steckelberg JM, et al. The impact of valve surgery on 6-month mortality in left-sided infective endocarditis. Circulation 2007;115:1721-8.
- Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramatic reduction in infective endocarditis-related mortality with a management-based approach. Arch Intern Med 2009;169:1290-8.