Diagnostic value of echocardiography for infective endocarditis in older adults

Diagnosing infective endocarditis (IE) in older adults remains challenging. We aimed to assess the diagnostic contribution of echocardiography in geriatric patients with suspected IE.

We conducted a retrospective multicenter cohort study in three university hospitals between May 2016 and April 2021. All consecutive episodes of suspected IE discussed by a multidisciplinary endocarditis team were included. Final team adjudication served as the reference standard. Duke classification was assessed before and after transthoracic (TTE) and/or transesophageal echocardiography (TEE). Patients were compared according to age (<75 versus ≥ 75 years).

A total of 184 suspected IE episodes (181 patients) were analyzed; median age was 74 years, and 49% were aged ≥ 75 years. Older patients had a higher Charlson comorbidity index (7.5 vs 4.5) and a higher 12-month mortality rate (37% vs 26% overall). TTE was performed in 96% of cases, whereas TEE was performed in only 38%, significantly less frequently in patients ≥ 75 years (23% vs 51%) and after a longer time (10.3 vs 5.6 days). Echocardiography modified Duke classification in 30% of cases overall, including 24% in patients ≥ 75 years. The proportion of definite IE increased from 8% before echocardiography to 33% after imaging, and from 9% to 28% in older patients. Echocardiography provided a major Duke criterion in 33% of cases, while findings were inconclusive in 25%. Neurological disorders and biological prosthetic valves were independently associated with echocardiographic diagnosis of IE.

Despite underuse and delayed TEE, echocardiography improved diagnostic classification.