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High morbidity and mortality in infective endocarditis persist. Surgical evaluation of endocarditis lesions is crucial, though echocardiogram sensitivity for certain anomalies is limited, impacting predictor identification.

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Infective endocarditis (IE) continues to present significant morbidity and mortality.
  • Surgery offers an optimal setting for evaluating IE-related cardiac lesions.
  • This study aimed to characterize IE lesions during surgery and identify predictors of outcomes.

Purpose of the Study:

  • To register and describe pathological lesions in infective endocarditis during surgery.
  • To identify predictors of morbidity and mortality in IE patients.
  • To correlate echocardiogram findings with surgical observations of IE lesions.

Main Methods:

  • Prospective coding of pathological lesions in 100 consecutive IE patients undergoing surgery (June 2014 - August 2018).
  • Retrospective collection of additional patient data.
  • Analysis of echocardiogram findings versus surgical descriptions.

Main Results:

  • Vegetations (77%) and valve integrity anomalies (71%) were common echocardiogram and surgical findings, respectively.
  • In-hospital mortality was 9%; predictors included chronic kidney disease, prosthetic valve endocarditis, and valve integrity anomalies.
  • Echocardiogram showed 84% sensitivity for vegetations but limited sensitivity for valve integrity anomalies (42%) and invasion (54%).

Conclusions:

  • The heterogeneity of IE lesions complicates the identification of robust morbidity/mortality predictors.
  • Echocardiography demonstrates high specificity but variable sensitivity for detecting IE-related cardiac damage.
  • Further research is needed to improve diagnostic accuracy and outcome prediction in infective endocarditis.