Infective Endocarditis

  • Trine K. Lauridsen
  • Anna Lisa CrowleyEmail author


Infective endocarditis (IE) is an infection of the endocardial lining of the heart, the heart valves, intracardiac devices or prosthetic valves. The infection is mainly localized on the valvular structures, on the low flow side of the valves or at locations with endocardial damage. In this chapter we will review the epidemiology of infective endocarditis (IE), the Modified Duke criteria for diagnosing IE and understand the role of echocardiography in the diagnosis of IE and complications, demonstrating echocardiograms of cases with native and prosthetic valve infective endocarditis, defining sensitivity and specificity of different echocardiographic modalities in native and prosthetic valve infective endocarditis and describing the diagnostic and prognostic role of echocardiographic findings in IE.


Endocarditis Cardiac infection Valvular complications 



Aortic valve


Infective endocarditis


Left atrium


Left ventricle


Left ventrivular outflow tract


Mitral valve


Right atrium


Transesophageal echocardiography


Transthoracic echocardiography

Supplementary material

Movie 19.1

: Long axis TEE view showing the aortic valve with an oscillating vegetation on the non-coronary cusp (AVI 25479 kb)

Movie 19.2

: Color Doppler reveals valvular destruction of the non-coronary cusp with severe aortic regurgitation (AVI 4090 kb)


  1. 1.
    Holland TL, Baddour LM, Bayer AS, Hoen B, Miro JM, Fowler VG Jr. Infective endocarditis. Nat Rev Dis Primers. 2016;2:16059. Scholar
  2. 2.
    Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2016;387(10021):882–93. Epub 2015 Sep 1 ReviewCrossRefPubMedGoogle Scholar
  3. 3.
    Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, et al. American Heart Association Committee: Infective endocarditis in adults: diagnosis, antimicrobial Therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435–86.CrossRefGoogle Scholar
  4. 4.
    Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075–128.CrossRefGoogle Scholar
  5. 5.
    Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.CrossRefGoogle Scholar
  6. 6.
    Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11:202–19.CrossRefGoogle Scholar
  7. 7.
    Reynolds HR, Jagen MA, Tunick PA, Kronzon I. Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era. J Am Soc Echocardiogr. 2003;16:67–70.CrossRefGoogle Scholar
  8. 8.
    Mugge A, Daniel WG, Frank G, Lichtlen PR. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol. 1989;14:631–8.CrossRefGoogle Scholar
  9. 9.
    Daniel WG, Mügge A, Martin RP, Lindert O, Hausmann D, Nonnast- Daniel B, et al. Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med. 1991;324:795–800.CrossRefGoogle Scholar
  10. 10.
    Lauridsen TK, Selton-Suty C, Tong S, Afonso L, Cecchi E, Park L, et al. Echocardiographic agreement in the diagnostic evaluation for infective endocarditis. Int J Cardiovasc Imaging. 2016;32(7):1041–51.CrossRefGoogle Scholar
  11. 11.
    Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation. 2005;112(1):69–75. Epub 2005 Jun 27. Erratum in: Circulation. 2005 Aug 30;112(9)CrossRefGoogle Scholar
  12. 12.
    Lauridsen TK, Park L, Tong SY, Selton-Suty C, Peterson G, Cecchi E, et al. Echocardiographic findings predict in-hospital and 1-year mortality in left-sided native valve Staphylococcus aureus endocarditis: analysis from the international collaboration on endocarditis-prospective Echo Cohort study. Circ Cardiovasc Imaging. 2015;8(7):e003397.CrossRefGoogle Scholar
  13. 13.
    Kiefer T, Park L, Tribouilloy C, Cortes C, Casillo R, Chu V, et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA. 2011;306(20):2239–4.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gentofte University HospitalCopenhagenDenmark
  2. 2.Duke University Medical CenterDurhamUSA

Personalised recommendations