The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry

Abstract

Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) European Endocarditis (EURO-ENDO) registry aims to study the care and outcomes of patients diagnosed with infective endocarditis (IE) and compare findings with recommendations from the 2015 ESC Clinical Practice Guidelines for the management of IE and data from the 2001 Euro Heart Survey. Methods and results Patients (n = 3116) aged over 18 years with a diagnosis of IE based on the ESC 2015 IE diagnostic criteria were prospectively identified between 1 January 2016 and 31 March 2018. Individual patient data were collected across 156 centres and 40 countries. The primary endpoint is all-cause mortality in hospital and at 1 year. Secondary endpoints are 1-year morbidity (all-cause hospitalization, any cardiac surgery, and IE relapse), the clinical, epidemiological, microbiological, and therapeutic characteristics of patients, the number and timing of non-invasive imaging techniques, and adherence to recommendations as stated in the 2015 ESC Clinical Practice Guidelines for the management of IE. Conclusion EURO-ENDO is an international registry of care and outcomes of patients hospitalized with IE which will provide insights into the contemporary profile and management of patients with this challenging disease.

Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

“…The echocardiography should be used to identify the vegetation and its localization, but a negative examination does not rule out the presence of infection. The Euro-Endo Registry showed that a high proportion (67%) of patients with CIED-IE received TOE, but a significant percentage of subjects (26% and 37%, respectively) also required PET/CT or chest CT [21]. This observation confirms the need for multidisciplinary work-up in CIED-IE.…”

“…Globally, the diagnostic sensitivity of TOE is about 85-90% [20]. According to the Euro-Endo registry, TTE has been performed in 91% of cases, while TOE in 53% of native valves' IE [21]. However, some heterogeneity in the diagnostic workup has been reported, with some countries having a more extensive use of imaging, possibly associated with a relatively low mortality [22].…”

“…The TOE is generally preferred as a first-line evaluation and it is also indicated in case of negative TTE, in both early and late PVE, and for the identification of periprosthetic abscess and leak (both major Duke criteria, Figure 5). The Euro-Endo Registry showed that TOE is generally performed in the 66% of subjects, showing a significant percentage of abscesses (19%), pseudoaneurysm (6%), and prosthetic dehiscence (11%) [21]. The limited sensitivity of Duke criteria in PVE supports the indication to repeat TOE when the clinical suspicion is high, according with the clinical evolution [47].…”

“…CIED-IE represents about 10% of total IE, with an in-hospital mortality of 15.3%, according with Euro-Endo Registry [21]. A wider use of CIEDs in the elderly contributes to the increased rate of CIED-IE, with an incidence of 1.9 per 1000 device/year reported in a population-based study [58].…”

“…In addition to the typical risk factors for IE (renal failure, corticosteroid use, congestive HF, and diabetes mellitus), other factors related to the surgical procedure may play a role in CIED-IE (i.e., type of intervention, device revision, use of temporary pacing, use of antimicrobial prophylaxis, and use of anticoagulation) [60]. Staphilococci accounts for 60-80% of the cases, with a significant proportion of S. aureus (about 50%), according with the Euro-Endo registry [21].…”