European Infective Endocarditis Registry (Euro-Endo)

Objectives and characteristics of the study

These publications represent the main goals of the European Endocarditis registry (EURO-ENDO): to describe the current diagnostic and management practices in IE in Europe and beyond, and to evaluate its outcome depending on the correct implementation and adherence to the 2009 ESC guidelines on IE.

Why study infective endocarditis?

Infective endocarditis (IE) is a severe disease, associated with high morbidity and in-hospital mortality. Despite improvements in diagnostic and therapeutic strategies, both the incidence and severity of the disease seem to be unchanged.

Reasons for this persistent poor prognosis are numerous and include older patients with more severe disease, changes in the epidemiologic profiles and more patients with prosthetic or device related IE (8-10).

• The epidemiological profile of IE has changed during the past years, with important differences between countries and increasing numbers of staphylococcal and nosocomial endocarditis cases (1, 8). The European Society of Cardiology (ESC) Euro Heart Survey programme dedicated to valvular heart disease performed in 2001 already provided some useful information regarding the management of IE across Europe at that time (11). Hitherto, no attempt has been made to update and implement the results of the Euro Heart Survey in the contemporary era. There is, thus, a need for a comprehensive and dedicated IE survey.
• New diagnostic and therapeutic strategies have been developed in order to improve the diagnosis and the prognosis of the disease. The Guidelines on the prevention, diagnosis, and treatment of IE of the ESC were published in 2009 and gave new insight into both the diagnostic and therapeutic management of these patients (12). However, how these recommendations are implemented in real world clinical practice has never been studied.
• Although echocardiography is the first and recommended diagnostic method in IE (13), other non-invasive imaging techniques have received increasing attention, including multislice computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging (PET-CT) (14-19). However, their availability and use in different countries are unknown.
• Finally, although early surgery is recommended in patients with complicated IE, its impact on prognosis is still debated (20-26). With the present IE registry, it will be possible to assess whether both the implementation of guidelines published in 2009 and the use of early surgery are associated with a reduction in in-hospital and 1-year mortality. Therefore, this registry will give us the unique opportunity to assess the characteristics of IE in Europe, the current use of imaging techniques, as well as the correct implementation of the ESC guidelines and its consequence in terms of prognosis. All this will help improve the diagnosis and management of IE in Europe.

Study design and methods

The EURO-ENDO registry is a prospective multicentre observational study of patients presenting in the echocardiographic or imaging laboratories for definite IE and treated and followed by European centres. Diagnostic methods, type of medical therapy, indications for surgery, and mode of follow-up will be obtained according to the usual practice of the participating centres.

Study Organisation

The Executive committee is chaired by Prof. Gilbert Habib (EACVI) and co-chaired by Prof. Patrizio Lancellotti (EACVI).

Executive Committee members

• Gilbert Habib, Chair, EACVI
• Patrizio Lancellotti, Co-Chair, EACVI and ESC WG VHD
• Erwan Donal, Executive Committee, EACVI
• Bernard Cosyns, Executive Committee, EACVI
• Bogdan A. Popescu, Executive Committee, EACVI
• Bernard Iung, ESC WG VHD
• Raphael Rosenhek, ESC WG VHD
• Bernard Prendergast, ESC WG VHD
• Pilar Tornos, ESC WG VHD
• Paola Erba, Nuclear Medicine, EACVI
• Aldo P Maggioni, Scientific Coordinator EORP, ex-officio (non-voting)

The Steering Committee is composed by the chairmen of the study and by the National Coordinator of each participating country selected by the EACVI in collaboration with the National Imaging Communities.

References

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