Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

Abstract

SummaryBackground: The optimal timing of the initial echocardiographic assessment and the influence of microorganisms on echocardiographic findings in patients with infective endocarditis (IE) are not well studied.Methods: In 274 patients with IE, we studied the impact of antibiotic treatment duration of ≤2 days (early, 119 patients) or >2 days (late, 144 patients) prior to diagnostic echocardiography on IE specific findings and on clinical outcomes. Results were stratified for patients with Staphylococcus aureus (SA patients, n = 84) and those with other causative organisms (non-SA patients, n = 190).Results: There were no differences on specific echocardiographic findings between patients with early versus late echocardiography: Presence of vegetations: 91% vs 86%, p = 0.25; size of vegetations: 1.5 ± 0.7 cm vs 1.5 ± 0.8 cm, p = 0.83; paravalvular abscess: 24% vs 24%, p = 0.88, or valve destruction: 44% vs 35%, p = 0.17. There were also no differences in terms of clinical outcomes between the two groups: Heart surgery for IE in 61% vs 53%, p = 0.21, and in-hospital death in 8% vs 11%, p = 0.46. The presence of SA was not associated with specific findings on echocardiography or worse clinical outcomes compared to non-SA patients.Conclusions: In patients with infective endocarditis, the findings of early vs late initial echocardiographic a ssessment did not differ, and echocardiographic findings did not allow inference on the causing organism. Neither the timing of the initial echocardiographic study nor any organism involved was associated with clinical outcome.

Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study

“…In our study, men were more likely to have aortic valve IE, which is partly adherent to previous studies [27,28]. The rates of in-hospital mortality and surgical treatment for IE in our study did not differ between men and women, which does not accord with previous reports indicating that women have higher mortality and receive surgical treatment to a lesser extent compared with men [10]. In our cohort, the in-hospital mortality rate was low (7%), which contrasts with previously reported rates of 15-20% [29,30], but is more in line with a Swedish study presenting a 30-days crude mortality rate of 10.4% [3].…”

“…Furthermore, we found that S. aureus infections were associated with tricuspid valve IE, which is supported by Bonetti et al in their study of 274 patients with IE [10].…”

“…However, this was not the case with prosthetic aortic valves. Further, significant associations were seen between viridans group streptococci and group B streptococcal infections and mitral valve vegetations and between HACEKand CIED-associated IE.Associations between specific bacterial infections and IE manifestations detected by ECHO have been reported previously[10,11]. Trifunovic et al could not show any associations between specific IE manifestations and certain etiologies in their study of 246 patients with IE, even though their main findings were that S. aureus and gram-negative bacteria caused large vegetations, CoNS caused destructive leaflet lesions, CoNS and gram-negative bacteria caused perivalvular extension of the infective process, and that gram-negative bacteria were associated with multiple manifestations in the same patient…”

“…Similar results were reported by Lauridsen et al who showed that perivalvular abscess and valve perforation independently predicted 1-year mortality in patients with left-sided native valve S. aureus-linked endocarditis [17].Furthermore, in our study, Streptococcus species were also common (27%), as was seen in studies presenting a high and increasing prevalence of streptococci in general, but more specifically viridans group streptococci and S. bovis [18,19]. SurgeryIn our study, 28% of patients underwent surgical treatment, slightly less than the 31% of Swedish patients with IE who underwent surgical treatment in 2017 [10]. This lower percentage in our cohort might be explained by the large proportion of patients with a history of IV drug abuse and right-sided IE, which were less frequently treated with cardiac surgery compared to the IE patients with no IV drug abuse.…”

“…Although identification of causative bacteria and IE specific cardiac manifestations are crucial for the diagnosis and treatment of IE, the studies on associations between microbiological data and ECHO findings are scarce and the published results diverging [10][11][12]. Therefore, our aim was to analyze whether there were relationships between the bacteria found in blood culture or from sites of infection found during cardiac surgery and specific IE manifestations detected by ECHO in a cohort of IE patients.…”