Clinical Advances in Endocarditis: From Diagnosis to Treatment

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

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