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End-of-Therapy Echocardiography May Not Be Needed in All in Patients With Endocarditis
Abinash Virk1, Kirsten M Schutte2, James M Steckelberg1
1Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Open Forum Infectious Diseases
|March 27, 2020
Summary
End-of-therapy echocardiography (ETE) for infective endocarditis (IE) may not be necessary for all patients. Most patients without new signs or symptoms at therapy completion do not require repeat treatment or surgery.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- The American Heart Association (AHA) guidelines suggest end-of-therapy echocardiography (ETE) for infective endocarditis (IE) management to establish a new baseline, based on expert opinion.
- The clinical utility and necessity of routine ETE in all IE patients remain subjects of ongoing discussion and research.
Purpose of the Study:
- To evaluate the utilization of ETE after infective endocarditis (IE) treatment.
- To assess the association between ETE findings, clinical signs/symptoms, and the need for re-treatment (antimicrobials or cardiovascular surgery) within one year post-therapy.
Main Methods:
- Retrospective review of medical records for IE patients treated between January 2005 and December 2011.
- Analysis of ETE utilization, clinical status (new/worsened signs or symptoms - new/w-SSx), ETE findings compared to baseline, and cumulative incidence of re-treatment (re-Rx/CVS) within one year.
Main Results:
- 72.8% of patients (177/243) underwent ETE. Of these, 75.1% (133/177) had no new/worsened signs or symptoms (new/w-SSx).
- 141/177 (79.7%) overall and 117/133 (87.9%) without new/w-SSx had no new ETE findings compared to initial echocardiography.
- New ETE findings were significantly more likely in patients with new/w-SSx (39.2% vs 8.3%, P < 0.001).
- Patients with new ETE findings or new/w-SSx had a substantially increased risk of re-Rx/CVS (HR 25.86 and 5.35, respectively). The highest risk was observed in patients with both (HR 45.94).
- Only 3.4% (7/187) of patients without new/w-SSx who had ETE required re-Rx/CVS.
Conclusions:
- The majority of IE patients without new/w-SSx at end-of-therapy (EOT) do not exhibit new ETE findings or require re-treatment within one year.
- New/worsened signs/symptoms at EOT are associated with new ETE findings and predict the need for re-treatment.
- Further research is warranted to determine the specific indications for ETE in IE patients without clinical signs of worsening post-therapy.
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