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The Evolving Landscape of Infective Endocarditis: Past, Present, and Future
Lawrence Lau1, Lydia Xing2, Larry M Baddour3
1Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
Abstract:
Infective endocarditis (IE) is a disease that has evolved over the past century in tandem with advances in medicine. Although initially reliant on histopathologic (and often postmortem) confirmation, the diagnostic approach has shifted toward reliance on microbiological culture and echocardiography as the cornerstones of diagnosis, as reflected by all iterations of diagnostic criteria. Recent developments in molecular diagnostics and advanced metabolic imaging techniques have enhanced the sensitivity and specificity of diagnosis, particularly in complex cases involving prosthetic material. While antimicrobial and surgical management strategies also have advanced incrementally, the affected patient population has concurrently become older and more medically complex, posing additional therapeutic challenges. Nevertheless, clinical outcomes have improved over time, though disparities in prognosis persist between high- and low-income settings. The increasing adoption of multidisciplinary management models and the establishment of international collaborative registries hold promise for generating globally representative data to inform future practice and reduce inequities in care in patients with IE.
Insights
Infective endocarditis (IE) diagnosis has advanced with molecular and imaging techniques. While treatments improved, older, complex patients face challenges, necessitating multidisciplinary care and global data sharing to reduce inequities.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Infective endocarditis (IE) has evolved significantly over the last century.
- Diagnostic methods shifted from histopathology to microbiology and echocardiography.
- Medical advancements have altered the patient population, increasing complexity.
Purpose of the Study:
- To review the evolution of infective endocarditis diagnosis and management.
- To highlight advancements in diagnostic sensitivity and specificity.
- To discuss current therapeutic challenges and future directions in IE care.
Main Methods:
- Review of historical and current diagnostic criteria for IE.
- Analysis of advancements in molecular diagnostics and metabolic imaging.
- Examination of evolving antimicrobial and surgical treatment strategies.
- Assessment of multidisciplinary management models and international registries.
Main Results:
- Modern diagnostics like molecular assays and advanced imaging improve IE detection.
- Patient populations are older and more medically complex, increasing treatment challenges.
- Clinical outcomes have improved, but disparities persist globally.
- Multidisciplinary care and collaborative registries are crucial for future progress.
Conclusions:
- IE diagnosis and management have been transformed by medical progress.
- Addressing the complexities of older, comorbid patients is essential.
- International collaboration and data sharing are vital to reduce global health inequities in IE care.
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