Radiology in Infective Endocarditis

In the last 50 years, the incidence of infective endocarditis (IE) has remained between 2 and 6 per 100.000 individuals in the general population per year and its mortality has fluctuated between 10% and 30%, depending on the type of pathogen. Historically, chronic rheumatic heart disease had being the primary risk factor for IE but in the last years, new at-risk groups have emerged like individuals undergoing hemodialysis, patients with catheters and elderly people with degenerative valve lesions. IE is characterized by the infection of the endocardium, most commonly by bacteria. Although the primary focus of the infection is confined to the endocardium, microbial shedding by continuous bacteremia and embolization of vegetation fragments makes IE a true systemic infection. This disease, therefore, is positioned at the crossroads of multiple medical specialties, including cardiology, cardiac surgery, infectious diseases, internal medicine, neurology, and intensive care. Valve vegetations are specific pathologic findings of this disease. They are the result of the combination of thrombus with bacteria and leucocytes. The size and mobility of valvular vegetations are important predictors of whether or not the patient will develop septic emboli. These lesions usually affect valve endocardium, but it also could involve papillary muscles, mural endocardium and the great vessels. IE is fatal if it is not treated early with antibiotics. Negative prognostic factors are fungal etiology, involvement of the aortic valve, and presence of large vegetations. Patients with a left-sided endocarditis have a higher mortality in comparison to patients with right-sided endocarditis