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Observational Study
. 2023 May;116(5):258-264.
doi: 10.1016/j.acvd.2023.04.001. Epub 2023 Apr 25.

The impact of transoesophageal echocardiography in elderly patients with infective endocarditis

Marie-Paule B N'cho-Mottoh  1 , Marie-Line Erpelding  2 , Claire Roubaud  3 , François Delahaye  4 , Thibaut Fraisse  5 , Marina Dijos  3 , Pierre-Vladimir Ennezat  6 , Arnaud Fluttaz  7 , Benjamin Richard  8 , Corinne Beaufort  9 , Pierre Nazeyrollas  10 , Camille Brasselet  11 , Olivier Pineau  12 , Pierre Tattevin  13 , Elodie Curlier  14 , Bernard Iung  15 , Emmanuel Forestier  7 , Christine Selton-Suty  16
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Free article
Observational Study

The impact of transoesophageal echocardiography in elderly patients with infective endocarditis

Marie-Paule B N'cho-Mottoh et al. Arch Cardiovasc Dis. 2023 May.
Free article

Abstract

Background: Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions.

Aim: To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality.

Methods: A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75-101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE.

Results: Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE.

Conclusions: Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.

Keywords: Elderly; Geriatric assessment; Infective endocarditis; Transoesophageal echocardiography.

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