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Special Issue "Multidisciplinary Endocarditis Perspectives"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 25 March 2024 | Viewed by 2316

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Dr. Giovanni La Canna

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Applied Diagnostic Echocardiography Unit, IRCCS Humanitas Clinical and Research Center, 20089 Rozzano, Italy
Interests: echocardiography; valvular heart disease; hypertrophic cardiomyopathy; mitral valve prolapse; endocarditis; post-radiation heart disease
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Special Issue Information

Dear Colleagues,

Endocarditis is a complex clinical pathology with a high mortality rate despite diagnostic and therapeutic improvements. In recent years, we have seen significant changes in its epidemiological and clinical profile, with a variation in the population at risk and increase in nosocomial forms of endocarditis with antibiotic-resistant or fastidious bacteria. Endocarditis is a great simulator when it occurs with an embolic event that might lead diagnosis towards other pathologies, or it may in turn be simulated by disparate diseases. Rapid diagnostic recognition and appropriate therapy are crucial to eradicate the infection, prevent embolism, and treat cardiac failure. Guidelines provide useful support, even though they are based mainly on the opinions of experts rather than on randomized studies, with some inconsistencies between medical scientific societies. Diagnostic and therapeutic management is therefore an important clinical challenge that often requires a tailored approach. Multi-specialist involvement with structured pathways may optimize the outcome.

This Special Issue focuses on multidisciplinary perspectives of endocarditis, including:

- The new scenario of prevention;

- New insights into the development of infective endocarditis;

- Diagnostic work-up;

- Clinical pathway of embolic syndrome;

- Management challenges;

- Clinical pathway of blood culture negative endocarditis;

- Extra-cardiac complications: other specialists on the pitch;

- Clinical pathway for cardiac device infections;

- The emerging challenge of endocarditis during the COVID-19 epidemic;

- Transcatheter implanted cardiac valve endocarditis: an emerging issue in the elderly population;

- Endocarditis and cancer.

Dr. Giovanni La Canna
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Open AccessArticle

Impact of Enterococci vs. Staphylococci Induced Infective Endocarditis after Transcatheter Aortic Valve Implantation

J. Clin. Med. 2023, 12(5), 1817; https://doi.org/10.3390/jcm12051817 - 24 Feb 2023

Cited by 1 | Viewed by 975

Abstract

Background: The two most common organisms found in infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) are enterococci (EC-IE) and staphylococci (SC-IE). We aimed to compare clinical characteristics and outcomes of patients with EC-IE and SC-IE. Methods: TAVI-IE patients from 2007 to 2021 were included in this analysis. The 1-year mortality was the primary outcome measure of this retrospective multi-center analysis. Results: Out of 163 patients, 53 (32.5%) EC-IE and 69 (42.3%) SC-IE patients were included. Subjects were comparable with regard to age, sex, and clinically relevant baseline comorbidities. Symptoms at admission were not significantly different between groups, except for a lower risk for presenting with septic shock in EC-IE than SC-IE. Treatment was performed in 78% by antibiotics alone and in 22% of patients by surgery and antibiotics, with no significant differences between groups. The rate of any complication, in particular heart failure, renal failure, and septic shock during treatment for IE, was lower in EC-IE compared with SC-IE (p < 0.05). In-hospital (EC-IE: 36% vs. SC-IE: 56%, p = 0.035) and 1-year mortality (EC-IE: 51% vs. SC-IE: 70%, p = 0.009) were significantly lower in EC-IE compared with SC-IE. Conclusions: EC-IE, compared with SC-IE, was associated with a lower morbidity and mortality. However, absolute numbers are high, a finding that should trigger further research in appropriate perioperative antibiotic management and improvement of early IE diagnosis in the case of clinical suspicion. Full article

(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)

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Surgical Challenges in Infective Endocarditis: State of the Art

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J. Clin. Med. 2023, 12(18), 5891; https://doi.org/10.3390/jcm12185891 - 11 Sep 2023

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Abstract

Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses. Full article

(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)

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Open AccessReview

Diagnostic Work-Up in Patients with Nonbacterial Thrombotic Endocarditis

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J. Clin. Med. 2023, 12(18), 5819; https://doi.org/10.3390/jcm12185819 - 07 Sep 2023

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Abstract

Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis that occurs in patients with predisposing conditions, including malignancies, autoimmune diseases (particularly antiphospholipid antibody syndrome, which accounts for the majority of lupus-associated cases), and coagulation disturbances for which the correlation with classical determinants is unclear. The condition is commonly referred to as “marantic”, “verrucous”, or Libman–Sacks endocarditis, although these are not synonymous, representing clinical–pathological nuances. The clinical presentation of NBTE involves embolic events, while local valvular complications, generally regurgitation, are typically less frequent and milder compared to infective forms of endocarditis. In the past, the diagnosis of NBTE relied on post mortem examinations, while at present, the diagnosis is primarily based on echocardiography, with the priority of excluding infective endocarditis through comprehensive microbiological and serological tests. As in other forms of endocarditis, besides pathology, transesophageal echocardiography remains the diagnostic standard, while other imaging techniques hold promise as adjunctive tools for early diagnosis and differentiation from infective vegetations. These include cardiac MRI and ¹⁸FDG-PET/CT, which already represents a major diagnostic criterion of infective endocarditis in specific settings. We will herein provide a comprehensive review of the current knowledge on the clinics and therapeutics of NBTE, with a specific focus on the diagnostic tools. Full article

(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)

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Open AccessReview

Early Biological Valve Failure: Structural Valve Degeneration, Thrombosis, or Endocarditis?

Maria Elisabetta Mancini

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J. Clin. Med. 2023, 12(17), 5740; https://doi.org/10.3390/jcm12175740 - 03 Sep 2023

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Abstract

Biological valve failure (BVF) is an inevitable condition that compromises the durability of biological heart valves (BHVs). It stems from various causes, including rejection, thrombosis, and endocarditis, leading to a critical state of valve dysfunction. Echocardiography, cardiac computed tomography, cardiac magnetic resonance, and nuclear imaging play pivotal roles in the diagnostic multimodality workup of BVF. By providing a comprehensive overview of the pathophysiology of BVF and the diagnostic approaches in different clinical scenarios, this review aims to aid clinicians in their decision-making process. The significance of early detection and appropriate management of BVF cannot be overstated, as these directly impact patients’ prognosis and their overall quality of life. Ensuring timely intervention and tailored treatments will not only improve outcomes but also alleviate the burden of this condition on patients’ life. By prioritizing comprehensive assessments and adopting the latest advancements in diagnostic technology, medical professionals can significantly enhance their ability to manage BVF effectively. Full article

(This article belongs to the Special Issue Multidisciplinary Endocarditis Perspectives)

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