Incidence, Clinical Characteristics, and Impact of Absent Echocardiographic Signs in Patients with Infective Endocarditis after Transcatheter Aortic Valve Implantation

Norman Mangner (1) , Vassili Panagides (2) , David del Val (2) , Mohamed Abdel-Wahab (3) , Lisa Crusius (1) , Eric Durand (4) , Nikolaj Ihlemann (5) , Marina Urena (6) , Costanza Pellegrini , Francesco Giannini (7) , Tomasz Gasior , Wojtek Wojakowski , Martin Landt , Vincent Auffret (8, 9, 10) , Jan-Malte Sinning (11) , Asim Cheema (12) , Luis Nombela-Franco , Chekrallah Chamandi (13) , Francisco Campelo-Parada (14) , Erika Munoz-Garcia (15) , Howard Herrmann , Luca Testa , Won-Keun Kim , Helene Eltchaninoff (4) , Lars Søndergaard , Dominique Himbert (6) , Oliver Husser , Azeem Latib (16) , Hervé Le Breton (10, 9) , Clement Servoz (14) , Philippe Gervais (2) , Mélanie Côté (2) , Holger Thiele (3) , David Holzhey (3) , Axel Linke (1) , Josep Rodés-Cabau (2)

1 TU Dresden - Technische Universität Dresden = Dresden University of Technology
2 ULaval - Université Laval [Québec]
3 Leipzig University / Universität Leipzig
4 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
5 Rigshospitalet [Copenhagen]
6 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
7 Ospedale San Raffaele
8 Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
10 LTSI - Laboratoire Traitement du Signal et de l'Image
11 University Hospital Bonn
12 St. Michael's Hospital
13 HEGP - Hôpital Européen Georges Pompidou [APHP]
14 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
15 Hospital Universitario Virgen de la Victoria = Virgen de la Victoria University Hospital
16 IRCCS Ospedale San Raffaele [Milan, Italy]

Background: Echocardiography is the primary imaging modality for diagnosis of infective endocarditis (IE) in prosthetic valve endocarditis (PVE) including IE after transcatheter aortic valve implantation (TAVI). This study aimed to evaluate the characteristics and clinical outcomes of patients with absent compared with evident echocardiographic signs of TAVI-IE. Methods: Patients with definite TAVI-IE derived from the Infectious Endocarditis after TAVI International Registry were investigated comparing those with absent and evident echocardiographic signs of IE defined as vegetation, abscess, pseudoaneurysm, intracardiac fistula or valvular perforation or aneurysm. Results: Among 578 patients, 87 (15.1%) and 491 (84.9%) had absent (IE-neg) and evident (IE-pos) echocardiographic signs of IE, respectively. IE-neg were more often treated via a transfemoral access with a self-expanding device, and had higher rates for peri-interventional complications (e.g. stroke, major vascular complications) during the TAVI procedure (p < 0.05 for all). IE-neg had higher rates of IE caused by staphylococcus aureus (33.7% vs. 23.2%, p = 0.038) and enterococci (37.2% vs. 23.8%, p = 0.009), but lower rates of coagulase-negative staphylococci (4.7% vs. 20.0%, p = 0.001).IE-neg was associated with the same dismal prognosis for in-hospital mortality in a multivariate binary regression analysis (OR 1.51, 95%-CI 0.55-4.12) as well as a for 1-year mortality in a Cox regression analysis (HR 1.10, 95%-CI 0.67-1.80). Conclusions: Even with negative echocardiographic imaging, patients who have undergone TAVI and presenting with positive blood cultures and symptoms of infection are a high-risk patient group having a reasonable suspicion of IE and the need for an early treatment initiation.

Mots clés: Duke criteria; TAVI; TEE; imaging; infective endocarditis

Domaines: Maladies infectieuses

Norman Mangner, Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Lisa Crusius, et al.. Incidence, Clinical Characteristics, and Impact of Absent Echocardiographic Signs in Patients with Infective Endocarditis after Transcatheter Aortic Valve Implantation. Clinical Infectious Diseases, 2022, ⟨10.1093/cid/ciac872⟩. ⟨hal-03886531⟩