The New Strategy in Infective Endocarditis: Early Surgery Based on Early Diagnosis

Patients with infective endocarditis (IE) have a poor prognosis because of complications such as congestive heart failure, paravalvular abscess formation, central and peripheral embolism, and hemorrhagic stroke.1 Patients with IE and congestive heart failure (CHF) have a mortality as high as 50%.1 The poor prognosis seems to not have improved in recent years.2 In Sweden, 7.603 patients with IE received a close follow-up with assessment of the 30-day mortality and 5-year follow-up including autopsy in all fatal events sampled from 1997 to 2007.2 During the observation period, no change of mortality was found despite an increase of the incidence of IE from about 7 to 7.5 per 100 000 to 8 to 8.5 per 100 000 inhabitants.2 To provide a contemporary picture of the presentation, cause, and outcome of IE, a worldwide International Collaboration on Endocarditis-Prospective Cohort Study (ICE PCS) was started in 58 hospitals in 25 countries in 2000.3 In this issue of Circulation , Chu VH et al4 report the recent 2008 to 2012 results of the ICE-PCS database of 1296 IE patients with left-sided IE. The hospital mortality for surgery, performed in only 661 (76%) of 863 patients with indications for surgery, reached 14.8% and the 6-month mortality reached 17.5% compared with 26% and 31.4%, respectively, when no surgery was provided.4Article see p 131Transesophageal echocardiography (TEE) opened a new window to the heart.5 TEE was found to be superior to transthoracic echocardiography (TTE), particularly for the diagnosis of IE.6–8 Using TEE sessile or mobile masses, attached to the cardiac valves, could be detected in patients with IE even when TTE was negative and even well before destruction of the valve leaflets.6–8 High resolution and image quality enabled …