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Clinical Advances in Endocarditis: From Diagnosis to Treatment

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

Deadline for manuscript submissions: 20 February 2027 | Viewed by 1291

Editors


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Guest Editor
The Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
Interests: endocarditis; infective endocarditis; valvular heart disease
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Guest Editor
Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel
Interests: endocarditis; myocardial infarction; heart disease

Special Issue Information

Dear Colleagues,

Endocarditis is a rare but serious disease, with outcomes remaining challenging despite improvements in diagnostic and treatment strategies. Expert endocarditis centers and multidisciplinary endocarditis teams have reduced mortality by improving diagnosis and optimizing surgical timing. However, the epidemiological and clinical characteristics of patients are rapidly changing due to the aging population and the widespread development and implantation of different types of percutaneous cardiac devices.

The increased use of transcatheter heart valve replacement procedures further exacerbates the challenging issue of prosthetic valve endocarditis, particularly in the elderly and debilitated population. In this setting, clinicians require specific studies to address optimal diagnostic and therapeutic strategies.

The sensitivity of the Duke criteria for diagnosing endocarditis related to intracardiac prostheses or devices has been enhanced by the use of cardiac CT and PET-CT. However, these modalities are in limited clinical use, both due to a lack of hardware and the high level of expertise required for meticulous interpretation of findings. Standardization of imaging criteria using parametric imaging is also needed to simplify interpretation, reduce inter- and intra-observer bias, and improve reproducibility.

Precise patient assessment based on imaging findings and identification of the pathogen is a key point for patients' risk stratification, decision-making about the proper treatment strategy, the timing of cardiac surgery if indicated, and intraoperative management. New microbiological techniques should also be explored, particularly the potential utility of metagenomic sequencing to improve etiological diagnosis in cases of blood culture-negative or fastidious bacteria-related endocarditis. The issue of post-operative antibiotic regimens is also debatable. Therefore, further research is needed to define the role of adaptive antibiotic regimens in preventing renal and neurological toxicity in the aging population.

Colleagues are invited to submit manuscripts that explore the above clinical issues.

Dr. Ram Sharony
Prof. Dr. Katia Orvin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

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Keywords

  • endocarditis
  • infective endocarditis
  • prosthetic valve endocarditis
  • TAVR endocarditis
  • advanced cardiac imaging

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Published Papers (2 papers)

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Research

20 pages, 564 KB  
Article
Real-World Infective Endocarditis in a Regional Hospital: Clinical Severity, Guideline Adherence, and Determinants of In-Hospital Outcomes
by Călin Pop, Lucian Liviu Pop, Maria Rebeca Petruș, Andreea Ioana Talpos, Roxana Hodas, Lavinia Pop and Iulia Pop
J. Clin. Med. 2026, 15(10), 3600; https://doi.org/10.3390/jcm15103600 - 8 May 2026
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Abstract
Background and Objectives: Infective endocarditis (IE) remains associated with high mortality, and real-world (RW) patients often differ from trial populations. We evaluated predictors of complications and mortality, the trial-eligibility gap, and temporal trends in guideline adherence across two periods (Period 1 [P1]: 2011–2016 [...] Read more.
Background and Objectives: Infective endocarditis (IE) remains associated with high mortality, and real-world (RW) patients often differ from trial populations. We evaluated predictors of complications and mortality, the trial-eligibility gap, and temporal trends in guideline adherence across two periods (Period 1 [P1]: 2011–2016 vs. Period 2 [P2]: 2017–2025) in a Romanian county hospital. Materials and Methods: We conducted a retrospective analysis of consecutive adult patients with definite IE. Patients were categorized as trial-eligible (TE) or RW according to predefined criteria. The composite endpoint included acute heart failure, cardiogenic or septic shock, embolic events, infectious complications, need for renal replacement therapy, and in-hospital mortality. We evaluated guideline adherence using a predefined quality indicator (QI) score ≥ 3. We identified independent predictors of outcome using multivariable logistic regression. Results: Among 206 patients (mean age 63.0 ± 14.8 years; 70.4% male), blood cultures were positive in 64.1%, with Staphylococcus aureus accounting for 14.1%. Vegetations were documented in 72.8%, and cardiac surgery was performed in 26.2%. Overall, at least one event from the composite endpoint occurred in 61.6%, and mortality was 32.5%. TE patients represented 63.1% of the cohort. Guideline adherence improved over time (QI ≥ 3: from 18.3% in P1 to 25.4% in P2, p = 0.32). In P2, the composite endpoint (66.8% vs. 42.9%, p = 0.002) and embolic events (31.8% vs. 8.2%, p < 0.001) were more frequent, whereas mortality remained unchanged (31.8% vs. 34.7%, p = 0.844). Sepsis at admission and left ventricular ejection fraction (LVEF) < 50% independently predicted adverse outcomes; model discrimination was acceptable, with an area under the curve (AUC) of 0.77. Conclusions: RW IE showed high complication rates and a persistent trial gap; improved guideline adherence was offset by greater clinical severity. Full article
(This article belongs to the Special Issue Clinical Advances in Endocarditis: From Diagnosis to Treatment)
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15 pages, 565 KB  
Article
Prognostic Value of HALP Score for In-Hospital Mortality in Patients with Infective Endocarditis
by Emirhan Hancıoğlu, Sevgi Özcan, Sevil Tuğrul Yavuz, Asım Enhoş and Ertuğrul Okuyan
J. Clin. Med. 2026, 15(7), 2707; https://doi.org/10.3390/jcm15072707 - 3 Apr 2026
Cited by 1 | Viewed by 552
Abstract
Background: Infective endocarditis (IE) remains associated with high morbidity and mortality despite advances in diagnostic and therapeutic strategies. Markers reflecting both inflammatory burden and nutritional status may improve early risk stratification. The hemoglobin-albumin-lymphocyte-platelet (HALP) score is a composite index integrating hematologic and [...] Read more.
Background: Infective endocarditis (IE) remains associated with high morbidity and mortality despite advances in diagnostic and therapeutic strategies. Markers reflecting both inflammatory burden and nutritional status may improve early risk stratification. The hemoglobin-albumin-lymphocyte-platelet (HALP) score is a composite index integrating hematologic and nutritional parameters; however, its prognostic value in IE has not been well established. Methods: This two-center retrospective cohort study included 218 adult patients hospitalized with IE between January 2016 and January 2025. HALP score was calculated from admission laboratory values. The primary outcome was in-hospital mortality, and 1-year mortality was evaluated as a secondary outcome. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value. Patients were categorized into low- and high-HALP groups, and survival was assessed using Kaplan–Meier analysis. Cox regression analyses were performed to identify independent predictors of in-hospital mortality. Results: A total of 218 patients were analyzed. In-hospital mortality occurred in 38.5% of patients. HALP score was significantly lower in non-survivors and was independently associated with in-hospital mortality. ROC analysis demonstrated good discriminatory performance (AUC 0.784), with an optimal cut-off value of 15.1 (sensitivity 73.9%, specificity 73.8%). Low HALP scores were associated with more advanced functional status, more frequent intracardiac complications, and higher rates of acute heart failure, renal failure, and septic shock. One-year mortality was also higher in the low-HALP group (42.9% vs. 18.2%, p = 0.005). Conclusions: HALP score is independently associated with in-hospital mortality in patients with IE and identifies a subgroup with more severe disease and worse outcomes. As an easily calculated parameter, it may serve as a complementary tool for risk stratification and clinical decision-making. Full article
(This article belongs to the Special Issue Clinical Advances in Endocarditis: From Diagnosis to Treatment)
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