Infective endocarditis (IE) is a severe condition with persistent high mortality risk. The aim of this study was to evaluate, in addition to clinical characteristics, the role of valvular lesions natural history based on repeated echocardiograms during in-hospital follow-up.

Patients hospitalised for IE with repeated echocardiography (defined by at least 2 in-hospital echocardiograms) at follow-up (FU) were retrospectively analysed.

Sixty-eight patients with a mean age of 65±17 years old were studied. Only Staphylococcus aureus was associated with a higher mortality in multivariate analysis (P=0.038). In patients medically treated (n=19), the global evolution of vegetation size was the following: increase in 15.8%, stability in 26.3%, decrease in 21.1%, and disappearance in 36.8%. There was a significant difference in survival at 1 year between the group with decrease or vegetation disappearance and the group with stability or increased size of the vegetation (respectively 100% versus 37.5%; P=0.0021; Fig. 1). In patients with surgical treatment (n=11), there was no significant difference regarding survival at 1 year according to preoperative evolution of vegetation size.

Mortality risk of IE was determined by the presence of Staphylococcus aureus infection. The echocardiographic evolution of valvular lesions in non-surgical patients impacts the prognosis but our preliminary series does not allow to draw definite conclusions.