IDENTIFICATION OF HIGH-RISK SUBGROUPS IN INFECTIVE ENDOCARDITIS AND THE ROLE OF ECHOCARDIOGRAPHY

The outcome of infective endocarditis remains poor. It has an overall mortality of around 30%, rising in high-risk subgroups to 50% and 100% . The prognosis can be improved by identification of high-risk patient s and special management. Patients with infective endocarditis are fou nd to be at high risk for death or serious complications when one or m ore of the following factors exist: old age (especially >60 years old) , delayed diagnosis, staphylococcal infection, aortic valve endocardit is, large valvular vegetation, congestive heart failure, embolization in the central nervous system or coronary artery, prosthetic valve inf ection, recurrent events, and failed antibiotic therapy. These factors often coexist and interrelate with one another. Early diagnosis and a ctive treatment are critical for a better clinical outcome. However, i nfective endocarditis is difficult to diagnose because of the atypical clinical manifestations and frequent negative results from blood cult ure. Echocardiography plays an indispensable role in the diagnosis and management of suspected or known infective endocarditis. By detecting and monitoring certain pathological changes associated with the disea se, e.g. vegetation, abscess formation, or valvular destruction, echoc ardiography helps to diagnose the disease early, to identify patients at high risk, to monitor the patients, and to optimize the timing and mode of surgical intervention. Serious complications can thus be avoid ed or cured at an early stage and the prognosis significantly improved .