Endocarditis and TAVR: Old Enemy, New Battlefield, New Weapon?

Global, regional, and national burden of infective endocarditis from 2010 to 2021 and predictions for the next five years: results from the Global Burden of Disease Study 2021

OBJECTIVE

To comprehensively evaluate the global, regional, and national burden of infective endocarditis (IE) from 2010 to 2021, and to project future trends.

METHODS

This study utilized data from the Global Burden of Disease (GBD) Study 2021. Statistical methods, including joinpoint regression and the auto-regressive integrated moving average (ARIMA) model, were employed to analyze the prevalence, mortality, and disability-adjusted life years (DALYs) of IE, stratified by gender, age, and socio-demographic index (SDI).

RESULT

From 2010 to 2021, the global prevalence of IE increased by 40.1%, with a total of 421,667 cases reported in 2021. The age-standardized prevalence rate (ASPR) rose from 4.7 per 100,000 to 5.3 per 100,000. Although the number of deaths increased by 23.01% and DALYs rose by 13.26%, both the age-standardized death rate (ASDR) and the age-standardized DALYs rate exhibited slight declines. Significant regional disparities in ASPR were observed, with an overall increase correlated with higher SDI levels. Joinpoint regression analysis revealed that the average annual percentage change (AAPC) in ASPR, ASDR, and age-standardized DALYs rate during this period was 0.8 (0.6, 1.0), -1.1 (-1.7, -0.5), and -1.3 (-1.9, -0.7), respectively. Notably, predictions from the ARIMA model indicate that the ASPR for men is expected to continue rising over the next five years, while a decline is anticipated for women; however, both genders are projected to experience a decrease in ASDR.

CONCLUSION

Over the past decade, the ASPR of IE has been on a gradual increase, while the ASDR and the age-standardized DALY rate have slightly decreased. It is indicated that some progress has been achieved in the global disease management and treatment effectiveness of IE. Based on the increasing prevalence rate and the relatively high mortality rate, the burden of IE globally will still remain a major public health challenge in the future.

Emerging and Re-Emerging Pathogens in Valvular Infective Endocarditis: A Review

Infective endocarditis (IE) is a microbial infection of the endocardial surface, most commonly affecting native and prosthetic valves of the heart. The epidemiology and etiology of the disease have evolved significantly over the last decades. With a growing elderly population, the incidence of degenerative valvopathies and the use of prosthetic heart valves have increased, becoming the most important predisposing risk factors. This change in the epidemiology has caused a shift in the underlying microbiology of the disease, with Staphylococci overtaking Streptococci as the main causative pathogens. Other rarer microbes, including Streptococcus agalactiae, Pseudomonas aeruginosa, Coxiella burnetti and Brucella, have also emerged or re-emerged. Valvular IE caused by these pathogens, especially Staphylococcus aureus, is often associated with a severe clinical course, leading to high rates of morbidity and mortality. Therefore, prompt diagnosis and management are crucial. Due to the high virulence of these pathogens and an increased incidence of antimicrobial resistances, surgical valve repair or replacement is often necessary. As the epidemiology and etiology of valvular IE continue to evolve, the diagnostic methods and therapies need to be progressively advanced to ensure satisfactory clinical outcomes.

Global magnitude and temporal trend of infective endocarditis, 1990-2019: results from the Global Burden of Disease Study

AIMS

To estimate the spatiotemporal patterns in infective endocarditis (IE) burden along with its attributable risk factors at the national, regional, and global levels, which is essential to optimize the targeted prevention, clinical practice, and research.

METHODS AND RESULTS

Based on all available data sources, the incidence, mortality, and disability-adjusted life years (DALYs) of IE in 204 countries and regions from 1990 to 2019 were reconstructed by Global Burden of Disease Study 2019 using the Cause of Death Ensemble model, spatiotemporal Gaussian process regression, and DisMod-MR 2.1. We depicted the epidemiological characteristics of IE in detail by gender, region, and age. Globally, 1 090 527 incident cases, 66 322 deaths, and 1 723 594 DALYs of IE were estimated in 2019. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) increased from 9.91 and 0.73 to 13.80 and 0.87 per 100 000 person-years over the past 30 years, respectively. ASIR were consistently more pronounced in higher socio-demographic index (SDI) regions. The leading ASMR in 2019 appeared in the High SDI region, with the largest increase in the past three decades. The age-specific burden rate of IE among people over 25 years old usually increased with age, and the annual increasing trend was more obvious for people over 60 years of age, especially in higher SDI regions.

CONCLUSION

The incidence and mortality of IE have continued to rise in the past 30 years, especially in higher SDI regions. The patient population was gradually shifting from the young to the elderly.