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Clinical Challenges in Endocarditis—2nd Edition
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Clinical Challenges in Endocarditis—2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (30 January 2025) | Viewed by 7152

Special Issue Editor

Dr. Antonio Salsano

E-Mail Website
Guest Editor
1. Division of Cardiac Surgery, Ospedale Policlinico San Martino, L.go Rosanna Benzi, 10, 16132 Genoa, Italy
2. Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
Interests: cardiac surgery; infective endocarditis; heart valve pathology; infections after surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I am pleased to invite you to contribute to this Special Issue entitled “Clinical Challenges in Endocarditis—2nd Edition”. For more details on the first volume, in which we published four papers, please visit
https://www.mdpi.com/journal/jcm/special_issues/Clinical_Endocarditis

Infectious endocarditis (IE) is a fatal and debilitating disease, and has been a growing problem in the last decade. It is estimated that IE affects 3–7.5 people per 100,000 person years, and its incidence is reported to be increasing in some parts of the world. IE more frequently affects men of around 60 years of age, with staphylococcal and enterococcal IE being the most frequent. Oral streptococcal endocarditis is less frequent, and its incidence has not increased since the implementation of the 2009 and 2015 recommendations restricting indications for antibiotic prophylaxis. There has been considerable focus on new methods of early diagnosis, such as PET or CT scans, which are now used in several countries. The prognosis of IE is still unacceptably poor, and more aggressive management of this deadly disease remains necessary. For this Special Issue, we encourage the submission of studies that investigate clinical challenges involving IE.

Dr. Antonio Salsano
Guest Editor

Manuscript Submission Information

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Keywords

  • cardiovascular surgery
  • infective endocarditis
  • heart valves pathology
  • diagnosis
  • management
  • therapy

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Related Special Issue

Published Papers (6 papers)

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Research

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17 pages, 2683 KiB  
Article
Early and Long-Term Outcomes of Patients Undergoing Surgery for Native and Prosthetic Valve Endocarditis: The Role of Preoperative Neutrophil-to-Lymphocyte Ratio, Neutrophil-to-Platelet Ratio, and Monocyte-to Lymphocyte Ratio
by Antonella Galeone, Jacopo Gardellini, Venanzio Di Nicola, Fabiola Perrone, Maria Serena Menzione, Renato Di Gaetano and Giovanni Battista Luciani
J. Clin. Med. 2025, 14(2), 533; https://doi.org/10.3390/jcm14020533 - 16 Jan 2025
Viewed by 703
Abstract
Background/Objectives: Previous studies evaluated the prognostic role of hematological parameters in predicting outcome in patients with infective endocarditis (IE). However, only a few studies evaluated the role of hematological parameters in patients undergoing surgery for IE. The aim of this study was to [...] Read more.
Background/Objectives: Previous studies evaluated the prognostic role of hematological parameters in predicting outcome in patients with infective endocarditis (IE). However, only a few studies evaluated the role of hematological parameters in patients undergoing surgery for IE. The aim of this study was to review our 20-year experience with the treatment of native (NVE) and prosthetic (PVE) valve endocarditis and to evaluate the role of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to monocyte ratio (NMR), and systemic inflammatory index (SII) on early and long-term outcomes of patients undergoing surgery for NVE and PVE. Methods: All adult patients undergoing surgery for NVE and PVE at our institution between January 2001 and December 2022 were included in the study. Preoperative NLR, NPR, PLR, MLR, NMR, and SII were calculated using hemograms with complete blood count. Results: During the study period, 503 patients, 371 (74%) males, median age 65 (52–73) years, underwent surgery for NVE (n = 337, 67%) or PVE (n = 166, 33%). Patients with PVE had significantly more aortic annulus abscess (95 (57%) vs. 51 (15%); p < 0.001), longer CPB (180 (131–235) vs. 105 (84–145) min; p < 0.001) and aortic cross-clamping times (129 (96–175) vs. 82 (64–114) min; p < 0.001), and received more aortic homografts (47 (28%) vs. 28 (9%); p < 0.001) and postoperative pacemaker implantation (25 (15%) vs. 20 (6%); p < 0.001 compared to patients with NVE. Preoperative NLR was 3.7 (2.4–6.1), NPR was 23 (16–37), PLR was 159 (106–210), NMR was 8.4 (6.6–12), MRL was 0.41 (0.29–0.62], and SII was 790 (485–1396). NLR, NPR, and MLR were significantly lower in patients with NVE compared to patients with PVE and in survivors compared to non-survivors. Overall mean survival time was 12.2 ± 0.5 years, with patients with NVE having better early and late survival compared to patients with PVE. Patients with preoperative NLR < 3.8, NPR < 30.9, and MLR < 0.4 had significantly better mean survival time compared to patients with preoperative NLR > 3.8, NPR > 30.9, and MLR > 0.4, respectively. Conclusions: In patients undergoing surgery for IE, preoperative higher NLR, NPR, and MLR are associated with increased early and long-term mortality. Full article
(This article belongs to the Special Issue Clinical Challenges in Endocarditis—2nd Edition)
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11 pages, 567 KiB  
Article
Mechanical versus Biological Valve Prostheses for Infective Endocarditis Presenting with Stroke
by Amila Kahrovic, Philipp Angleitner, Harald Herkner, Paul Werner, Alexandra Andreeva, Thomas Poschner, Severin Laengle, Alfred Kocher, Guenther Laufer and Martin Andreas
J. Clin. Med. 2024, 13(19), 5712; https://doi.org/10.3390/jcm13195712 - 25 Sep 2024
Viewed by 967
Abstract
Objectives: This study aimed to compare the clinical outcomes of mechanical and biological valve prostheses in patients with infective endocarditis presenting with stroke. Methods: Ninety-five adults with infective endocarditis complicated by stroke at baseline who underwent aortic and/or mitral valve replacement were analyzed [...] Read more.
Objectives: This study aimed to compare the clinical outcomes of mechanical and biological valve prostheses in patients with infective endocarditis presenting with stroke. Methods: Ninety-five adults with infective endocarditis complicated by stroke at baseline who underwent aortic and/or mitral valve replacement were analyzed retrospectively. The primary outcome was a composite outcome of all-cause mortality, ischemic stroke, hemorrhagic stroke, and re-endocarditis. Secondary outcomes included the individual components of the composite outcome and modified Rankin scale deterioration during follow-up. Results: Among the study cohort, 34 patients (35.8%) received mechanical valve prostheses and 61 (64.2%) received biological valve prostheses. Implantation of a mechanical valve prosthesis seems to be associated with a decreased risk of attaining the composite outcome (adjusted HR 0.46, 95% CI 0.22–0.96, and p = 0.037). Analyses of the individual components of the composite outcome showed that implantation of a mechanical valve prosthesis might not be associated with an increased risk of ischemic stroke, hemorrhagic stroke, and all-cause mortality during the follow-up period. Further, the risk of re-endocarditis was significantly lower in recipients of a mechanical valve prosthesis (adjusted HR 0.15, 95% CI 0.06–0.77, p = 0.026). Notably, a trend toward decreased risk of modified Rankin scale deterioration throughout the follow-up period was observed in this group (adjusted odds ratio 0.22, 95% CI 0.05–1.02, p = 0.053). Conclusions: Implantation of mechanical valve prostheses in patients presenting with infective endocarditis complicated by stroke seems to be beneficial in terms of a reduced risk of experiencing a composite outcome. Analyses of larger cohorts are required to validate our findings. Full article
(This article belongs to the Special Issue Clinical Challenges in Endocarditis—2nd Edition)
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11 pages, 783 KiB  
Article
Homograft Aortic Root Replacement for Destructive Prosthetic Valve Endocarditis: Results in the Current Era
by Marco Pocar, Cristina Barbero, Matteo Marro, Luisa Ferrante, Andrea Costamagna, Luigina Fazio, Michele La Torre, Massimo Boffini, Stefano Salizzoni and Mauro Rinaldi
J. Clin. Med. 2024, 13(15), 4532; https://doi.org/10.3390/jcm13154532 - 2 Aug 2024
Viewed by 1146
Abstract
Background: Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. Methods: A retrospective analysis was conducted on 61 consecutive patients who [...] Read more.
Background: Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. Methods: A retrospective analysis was conducted on 61 consecutive patients who underwent a cardiac reoperation comprising homograft aortic root replacement since 2010. The probabilities of survival were calculated with the Kaplan–Meier method, whereas multivariable regression served to outline the predictors of adverse events. The endpoints were operative/late death, perioperative low cardiac output and renal failure, and reoperations. Results: The operative (cumulative hospital and 30-day) mortality was 13%. The baseline aspartate transaminase (AST) and associated mitral procedures were predictive of operative death (p = 0.048, OR [95% CIs] = 1.03 [1–1.06]) and perioperative low cardiac output, respectively (p = 0.04, OR [95% CIs] = 21.3 [2.7–168.9] for valve replacement). The latter occurred in 12 (20%) patients, despite a normal ejection fraction. Survival estimates (±SE) at 3 months, 6 months, 1 year, and 3 years after surgery were 86.3 ± 4.7%, 82.0 ± 4.9%, 75.2 ± 5.6, and 70.0 ± 6.3%, respectively. Survival was significantly lower in the case of AST ≥ 40 IU/L (p = 0.04) and aortic cross-clamp time ≥ 180 min (p = 0.01), but not when excluding operative survivors. Five patients required early (two out of the five, within 3 months) or late (three out of the five) reoperation. Conclusions: Homograft aortic root replacement for destructive prosthetic valve endocarditis can currently be performed with a near 90% operative survival and reasonable 3-year mortality and reoperation rate. AST might serve to additionally stratify the operative risk. Full article
(This article belongs to the Special Issue Clinical Challenges in Endocarditis—2nd Edition)
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10 pages, 398 KiB  
Article
Performance of Risk Scores in Predicting Infective Endocarditis in Patients with Staphylococcus aureus Bacteraemia in a Prospective Asian Cohort
by Jinghao Nicholas Ngiam, Matthew Chung Yi Koh, Sophia Archuleta, Dale Fisher, Louis Yi-Ann Chai, Ching-Hui Sia, William K. F. Kong and Paul Anantharajah Tambyah
J. Clin. Med. 2024, 13(10), 2947; https://doi.org/10.3390/jcm13102947 - 16 May 2024
Viewed by 1624
Abstract
Background: Several risk scores have been derived to predict the risk of infective endocarditis (IE) amongst patients with Staphylococcus aureus bacteraemia (SAB), which helps to guide clinical management. Methods: We prospectively studied 634 patients admitted with SAB. The cohort was stratified [...] Read more.
Background: Several risk scores have been derived to predict the risk of infective endocarditis (IE) amongst patients with Staphylococcus aureus bacteraemia (SAB), which helps to guide clinical management. Methods: We prospectively studied 634 patients admitted with SAB. The cohort was stratified into those with or without IE, and the PREDICT Day 1, Day 5 and VIRSTA scores were tabulated. Area under the receiver operating characteristic (AUC) curves were constructed to compare the performance of each score. Results: Of the 634 patients examined, 36 (5.7%) had IE. These patients were younger (51.6 ± 20.1 vs. 59.2 ± 18.0 years, p = 0.015), tended to have community acquisition of bacteraemia (41.7% vs. 17.9%, p < 0.001), and had persistent bacteraemia beyond 72 h (19.4% vs. 6.0%, p = 0.002). The VIRSTA score had the best performance in predicting IE (AUC 0.76, 95%CI 0.66–0.86) compared with PREDICT Day 1 and Day 5. A VIRSTA score of <3 had the best negative predictive value (97.5%), compared with PREDICT Day 1 (<4) and Day 5 (<2) (94.3% and 96.6%, respectively). Conclusions: Overall, the risk scores performed well in our Asian cohort. If applied, 23.5% of the cohort with a VIRSTA ≥ 3 would require TEE, and a score of <3 had an excellent negative predictive value. Full article
(This article belongs to the Special Issue Clinical Challenges in Endocarditis—2nd Edition)
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Review

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13 pages, 1663 KiB  
Review
Contemporary Role of Positron Emission Tomography (PET) in Endocarditis: A Narrative Review
by Antonio Maria Sammartino, Giovanni Battista Bonfioli, Francesco Dondi, Mauro Riccardi, Francesco Bertagna, Marco Metra and Enrico Vizzardi
J. Clin. Med. 2024, 13(14), 4124; https://doi.org/10.3390/jcm13144124 - 15 Jul 2024
Cited by 2 | Viewed by 1770
Abstract
Endocarditis, a serious infectious disease, remains a diagnostic challenge in contemporary clinical practice. The advent of advanced imaging modalities has contributed significantly to the improved understanding and management of this complex disease. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging has shown remarkable potential [...] Read more.
Endocarditis, a serious infectious disease, remains a diagnostic challenge in contemporary clinical practice. The advent of advanced imaging modalities has contributed significantly to the improved understanding and management of this complex disease. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging has shown remarkable potential in improving the diagnostic accuracy of endocarditis. In the update of the Modified Duke Criteria, in 2023, The International Society for Cardiovascular Infectious Diseases (ISCVID) Working Group recognized specific 18F-FDG PET/CT findings as a major diagnostic criterion, particularly in patient with prosthetic valve endocarditis. The ability of PET to visualize metabolic activity allows for the identification of infective foci and could differentiate between infective and non-infective processes. This review examines the clinical utility of PET in differentiating infective endocarditis from other cardiovascular pathologies, highlighting its sensitivity and specificity in detecting native and prosthetic valve infections, including patients with transcatheter aortic valve implantation (TAVI), cardiac implantable devices (CIEDs), and left ventricular assistance devices (LVAD). Also, practical aspects and indications are illustrated to optimize the quality of imaging and reduce potential false positive results. In conclusion, the current use of PET in endocarditis has become a valuable diagnostic tool; as technological advances continue, PET will play an increasingly important role in the multidisciplinary approach to the management of endocarditis. Full article
(This article belongs to the Special Issue Clinical Challenges in Endocarditis—2nd Edition)
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Other

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6 pages, 1348 KiB  
Case Report
Surgical Approach for TAVI Replacement in Endocarditis: A Descriptive Technique
by Sébastien D’ulisse, Karim Homsy, Sotirios Marinakis, Serge Cappeliez and Badih El Nakadi
J. Clin. Med. 2025, 14(7), 2348; https://doi.org/10.3390/jcm14072348 - 29 Mar 2025
Viewed by 274
Abstract
Background/Objectives: Transcatheter Aortic Valve Implantation (TAVI) has significantly improved the management of aortic valve disease, but post-TAVI infective endocarditis, occurring in 0.5–3.1% of cases, remains a serious complication. Due to a high mortality rate and technical challenges, surgical replacement of infected TAVI prosthetic [...] Read more.
Background/Objectives: Transcatheter Aortic Valve Implantation (TAVI) has significantly improved the management of aortic valve disease, but post-TAVI infective endocarditis, occurring in 0.5–3.1% of cases, remains a serious complication. Due to a high mortality rate and technical challenges, surgical replacement of infected TAVI prosthetic valves is performed in only 11.4% of cases. Methods: This case describes a standardized surgical technique for the removal and replacement of self-expanding TAVI prosthetic valves in the case of infective endocarditis. Results: The proposed approach aims to facilitate valve explantation while minimizing surgical risks. Conclusions: We believe that this technique could be particularly beneficial for surgeons managing these complex cases, by reducing surgical complications and improving patient outcomes. Further studies are necessary to validate its long-term efficacy and applicability in broader clinical settings. Full article
(This article belongs to the Special Issue Clinical Challenges in Endocarditis—2nd Edition)
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