European Infective Endocarditis RegistryEURO-ENDOEACVI / VHD Working Group Registry

an ESC EURObservational Research Programme

Protocol22 January 2016
Version 1.0

Study Sponsored by the European Society of Cardiology
Chairs of the Executive Committee:
Gilbert Habib, EACVI, Chairman
Patrizio Lancellotti, ESC WG-VHD, Co-Chair

Coordinating Centre:
EURObservational Research Programme
European Society of Cardiology
Les Templiers
2035 Route des Colles
CS 80179 Biot
06903 Sophia Antipolis
Tel: +33(0)492 94 76 00
Fax: +33(0)492 94 76 29
Email: eorp@escardio.org

Property of European Society of Cardiology (ESC) - Confidential
May not be used, divulged, published, or otherwise disclosed without the written consent of ESC
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EURO ENDO 22 JAN 2016 Version 1.0

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Protocol history
Changes in the protocol appendices will not be subject to protocol amendments, in particular
the lists of the members of the registry committees as these are subject to potential changes.
The functions represented in the committees will however not change.

ProtocolversionNumber
1.0

ProtocolVersion date

Amended pages

22 Jan 2016

Not Applicable

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Not Applicable (first Version)

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List of abbreviations
Abbreviation

Definition

CRF, eCRF

Case Report Form, Electronic Case Report Form

EORP

EURObservational Research Programme

ESC

European Society of Cardiology

EACVI

Cardiovascular Imaging Association

EURO-ENDO

European Endocarditis

IE

Infective Endocarditis

VHD

Valvular Heart Disease

CT

Computed Tomography

MRI

Magnetic Resonance Imaging

PET-CT

Nuclear Imaging: Positron Emission Tomography - Computed
Tomography

TTE

Transthoracic Echocardiogram

TOE

Transesophageal Echocardiogram

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Table of content
Protocol history ........................................................................................................................................... 3
List of abbreviations .................................................................................................................................... 4
Table of content........................................................................................................................................... 5
1.

Background and rationale .................................................................................................................... 6

2.

Objectives and end-points of the study: ............................................................................................... 6
2.1.

Primary objective: ....................................................................................................................6

2.2.

Secondary objectives: ...............................................................................................................6

2.3.

End-points ...............................................................................................................................73.

Study design and methods ................................................................................................................... 7

4.

Selection of population ........................................................................................................................ 85.

Selection of Countries .......................................................................................................................... 8

6.

Selection of Centres ............................................................................................................................. 8

7.

Inclusion and Exclusion Criteria ........................................................................................................... 8
7.1.

Inclusion Criteria ......................................................................................................................8

7.2.

Exclusion Criteria .................................................................................................................... 10

8.

Patient visits ...................................................................................................................................... 10

9.

Variables Collected............................................................................................................................. 10
9.1.

Baseline Data ......................................................................................................................... 10

9.2.

Follow-up Data ....................................................................................................................... 10

9.2.1.

One-month follow-up: complications under therapy .................................................................... 10

9.2.2.

Long-Term follow-up ............................................................................................................... 11

10. Data management .............................................................................................................................. 11
10.1.

Case Report Form ................................................................................................................... 11

10.2.

Central Database .................................................................................................................... 11

10.3.

Progress Status Reports .......................................................................................................... 11

11. Statistical considerations and sample size ......................................................................................... 12
12. Study organisation ............................................................................................................................. 12
12.1.

Oversight Committee .............................................................................................................. 12

12.2.

Executive Committee .............................................................................................................. 12

12.3.

Steering Committee ................................................................................................................ 1212.4.

European Society of Cardiology coordinating centre (EORP Department) ....................................... 13

12.5.

Investigator Centres ............................................................................................................... 13

13. Duration of Registry ........................................................................................................................... 13
14. Ethical issues ..................................................................................................................................... 13
14.1.

Protection of Human Subject .................................................................................................... 14

15. Pharmacovigilance ............................................................................................................................. 14
16. Local monitoring ................................................................................................................................ 14
17. Publication Policy ............................................................................................................................... 15
18. References ......................................................................................................................................... 15
Appendix 1:

Oversight Committee members .......................................................................................... 18

Appendix 2:

Executive Committee members .......................................................................................... 19

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1.

Background and rationale

Infective endocarditis (IE) is a severe disease, associated with high morbidity and in-hospitalmortality (1-7). Despite improvements in diagnostic and therapeutic strategies, both theincidence and severity of the disease seem to be unchanged. Reasons for this persistent poor
prognosis are numerous and include older patients with more severe disease, changes in theepidemiologic profiles and more patients with prosthetic or device related IE (8-10).
The motivations for creating a European Endocarditis Registry are the following:The epidemiologic profile of IE has changed during the past years, with importantdifferences between countries and increasing numbers of staphylococcal and nosocomial
endocarditis cases (1, 8). The European Society of Cardiology (ESC) Euro Heart Survey
programme dedicated to valvular heart disease performed in 2001 already provided some
useful information regarding the management of IE across Europe at that time (11).
Hitherto, no attempt has been made to update and implement the results of the Euro Heart
Survey in the contemporary era. There is, thus, a need for a comprehensive and dedicated
IE survey.



New diagnostic and therapeutic strategies have been developed in order to improve thediagnosis and the prognosis of the disease. The Guidelines on the prevention, diagnosis,
and treatment of IE of the ESC were published in 2009 and gave new insight into both thediagnostic and therapeutic management of these patients (12). These recommendations
were revised in 2015 (28) However, how these recommendations are implemented in realworld clinical practice has never been studied.

Although echocardiography is the first and recommended diagnostic method in IE (13),other non-invasive imaging techniques have received increasing attention, including
multislice computed tomography (CT), magnetic resonance imaging (MRI), and nuclear
imaging (PET-CT) (14-19). However, their availability and use in different countries are
unknown.

Finally, although early surgery is recommended in patients with complicated IE, its impact
on prognosis is still debated (20-26). With the present IE registry, it will be possible toassess if both the implementation of guidelines and the use of early surgery are associatedwith a reduction in in-hospital and 1-year mortality.

Therefore, this registry will give us the unique opportunity to assess the characteristics of IE in
Europe, the current use of imaging techniques, as well as the correct implementation of the
ESC guidelines and its consequence in terms of prognosis. All this will help improve thediagnosis and management of IE in Europe.

2.

Objectives and end-points of the study:
2.1.

Primary objective:

The main goal of the European Endocarditis Registry (EURO-ENDO) is to evaluate the outcomeof patients diagnosed with Infective Endocarditis.

2.2.
Secondary objectives:

The secondary objectives are:-

To assess the current clinical, epidemiological, microbiological, therapeutic, andprognostic characteristics of IE in Europe.

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-To assess the current practices of imaging in IE in Europe and in affiliatedcountries-

To assess the degree of implementation of the ESC guidelines in practice.

-

To compare these current data with those obtained in the Euro Heart Survey.

2.3.

End-points

The primary end-point is to evaluate the in-hospital mortality and the 1-year mortality

The Secondary end-points will be evaluated by the following endpoints:
1.

1-year morbidity (hospitalisations, need for surgery, relapses)2.

Long-Term mortality

3.

The clinical, epidemiological, microbiological, and therapeutic characteristics.

4.

The number and timing of non invasive imaging techniques performed.

5.

The implementation of the ESC guidelines, concerning:

3.

-

The practical use of echocardiography-

The type and duration of antibiotic therapy-

The indications and timing of surgical therapy

Study design and methods

The EURO-ENDO registry is a prospective multicentre observational study of patients
presenting in the echocardiographic or imaging laboratories for definite IE and treated andfollowed by European centres and in ESC affiliated countries. Diagnostic methods, type of
medical therapy, indications for surgery, and mode of follow-up will be obtained according to
the usual practice of the participating centres.
Data on morbidity and mortality will be recorded at 1 month (e.g. in-hospital), 12 months, and2, 3, and 4 years after the enrolment in the registry. This information will be collected either
by phone call or during an outpatient scheduled visit in each centre.
Standard management of patients will be performed as per routine clinical practice.
Drug prescriptions and indications to perform diagnostic/therapeutic procedures will becompletely left to participating cardiologists’ decision.
No specific protocols or recommendations for evaluation, management, and/or treatment will
be put forth during this observational study.

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4.

Selection of population

All patients hospitalized with a diagnosis of Infective Endocarditis.
No data will be collected before detailed information is given to the patient and a signed
informed consent is obtained.

5.

Selection of Countries

Due to the substantial geographic variations in the epidemiology of Infective Endocarditis
among the European countries, this registry is aimed at generating data on internationalvariability in disease presentation and management. All the ESC countries will be informed
about the launching of the registry and they will have the possibility to propose centres. This
strategy should ensure representativeness of the data collected in Europe and possibly beyond.

6.

Selection of Centres

The investigator centres are accepted on a voluntary basis and any centre of any volume ofactivity can participate. A specific analysis on the patients’ outcomes will be done splitting thecenters in two subgroups: high and low volume as defined below. Centres will be appointed by
the Executive Committee in collaboration with the National Imaging Community. The centres
will be selected by the National coordinator of each country, although the NS presidents andthe executive committee members will also have the possibility to propose additional centres.
The completeness of recruitment of patients will be obtained by selection of patients either
from the echocardiographic laboratories, since all patients with IE beneficiate echo
examination, whatever the referring centre, or from hospital centres treating patients with IE.
The aim is to select 5 to 15 centres (depending of the size of the country and the number of
inhabitants) in each participating country and from approximately 30 countries which are
expected to be at least 20 inside and 5 outside of Europe.
The selected centres are approved by the EACVI association as high level IE centres: highvolume of treated patients (≥ 20 patients per year), and experts in IE treatment: diagnosis
management, imaging and surgical therapy. Low volume centres (< 20 patients per year) andwithout surgical capabilities may also participate in the registry.

7.

Inclusion and Exclusion Criteria
7.1.

Inclusion Criteria

Patients aged more than 18 years.



Patients having signed an informed Consent.

All patients with definite infective endocarditis, based on ESC 2015 diagnostic criteria, orPatients with only possible IE, but considered and treated as IE

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Table 1 - ESC 2015 diagnostic criteria (28)Major criteria
1.

Blood cultures positive for IE
a. Typical microorganisms consistent with IE from 2 separate blood cultures:‒

Viridans streptococci, Streptococcus gallolyticus (S bovis), HACEK group, S. aureus; or‒Community-acquired enterococci, in the absence of a primary focus; orb. Microorganisms consistent with IE from persistently positive blood cultures:‒≥2 positive blood cultures of blood samples drawn >12 h apart; or‒

All of 3 or a majority of ≥4 separate cultures of blood (with first and last samples drawn ≥1 h apart); or

c. Single positive blood culture for Coxiella burnetii or phase I IgG antibody titre >1:800
2.

Imaging positive for IE
a. Echocardiogram positive for IE:‒

Vegetation;‒

Abscess, pseudoaneurysm, intracardiac fistula;‒

Valvular perforation or aneurysm‒

New partial dehiscence of prosthetic valveb. Abnormal activity around the site of prosthetic valve implantation detected by 18F-FDG PET/CT (only if theprosthesis was implanted for >3 months) or radiolabelled leukocytes SPECT/CT
c . Definite paravalvular lesions by cardiac CT
Minor criteria
1.

Predisposition such as predisposing heart condition, or injection drug use

2.

Fever defined as temperature >38°C

3.

Vascular phenomena (including those detected only by imaging):: major arterial emboli, septic pulmonary infarcts,
infectious (mycotic) aneurysm, intracranial haemorrhage, conjunctival haemorrhages, and Janeway’s lesions

4.

Immunological phenomena: glomerulonephritis, Osler’s nodes, Roth’s spots, and rheumatoid factor

5.

Microbiological evidence: positive blood culture but does not meet a major criterion as noted above or serologicalevidence of active infection with organism consistent with IE

Table 2 - Definition of IE according to the modified Duke criteria (adapted from Li (27))
Definite IE
Pathological criteriaMicroorganisms demonstrated by culture or histological examination of a vegetation, a vegetation that has embolized, oran intracardiac abscess specimen; orPathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active
endocarditis

Clinical criteria

2 major criteria; or

1 major criterion and 3 minor criteria; or

5 minor criteria

Possible IE

1 major criterion and 1 minor criterion; or

3 minor criteria

Rejected IEFirm alternate diagnosis orResolution of IE syndrome with antibiotic therapy for ≤4 days; orNo pathological evidence of IE at surgery or autopsy, with antibiotic therapy for ≤4 days; orDoes not meet criteria for possible IE, as above

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7.2.


Exclusion Criteria

Patients already included in an interventional clinical study which would interfere with thepatient’s usual care.
Note: participation in observational studies is not considered as an exclusion criteria.

8.

Patient visits

Data will be collected in the main part in all patients at the time of diagnosis during the
hospital stay and at 1, 2, 3 and 4 years after enrolment either by phone call or during an
outpatient scheduled visit in each centre.

9.

Variables Collected

No data will be collected before detailed information on the study is given to the patient and asigned informed consent is obtained. After informed consent, the following data will becollected at inclusion and during hospitalisation.

9.1.

Baseline Data

The following information will be captured for each enrolled patient:Clinical data: age, sex, weight, height, cardiac and non cardiac history, comorbidity index(Charlson index (30)), date and timing of first signs and symptoms, underlying cardiac
disease, at-risk situation or procedure, Roth’s spots, temperature, Janeway,’s lesions,conjunctival haemorrhages, and Janeway’s lesions (Charlson comorbidity index), cardiac
murmur, heart failure signs, neurological complication, septic shock, AV block.



Biological and microbiological data: sedimentation rate, C-reactive protein,creatininemia, haemoglobin, white blood cells, platelets count. Blood cultures andserologies will be performed as recommended.



Echocardiographic data: vegetation, abscess, pseudo-aneurysm, valvular andperivalvular lesions, valve regurgitation or stenosis, as well as complete standard
echocardiographic studies. Both TTE and TOE will be performed, unless contra-indications
exist.



Other imaging techniques: results of other imaging techniques performed at admission
and during hospitalization will be reported, including CT scan, PET-CT, and cerebral or
cardiac MRI.

Treatment before admission and during hospitalization: including antibiotic therapy
and all other treatments.

9.2.
9.2.1.

Follow-up Data
One-month follow-up: complications under therapy

The following occurring events during hospitalisation will be reported, including:Embolic event

infectious complication



Haemodynamic complications

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Need for surgery

Overall mortality

Cardiovascular death9.2.2.

Long-Term follow-up

The following occurring events at 1, 2, 3, or 4-year follow-up will be reported, including:Mortality and related causes

Recurrence and relapse



Hospitalisations and related causes

Surgical valvular intervention

10. Data management
10.1.

Case Report Form

Data Collecting Officers/Investigators of the participating centres will have access to theelectronic case report form, through login on the EORP website, for on-line data entry.
Individual Login names and passwords will be distributed by the EORP team to theparticipating centres.
The paper version of the CRF can be downloaded from the webpage to provide the opportunity
to collect data on paper before entering it in the eCRF. Edit checks will be implemented in theEuropean Heart House. Patient identification will not be transferred to the central database.

10.2.

Central Database

A central database is used to collect data from all EORP registries at the European Heart Housein France. A registry-specific central database will be set up to contain the data for this study,
from which data analysis will be performed. The database has limited access, protected byindividual passwords; with the hardware being locked in a server room. Backups are encrypted
and stored off site.
The database will be maintained at the European Heart House, according to the requirements
defined by the appointed Executive Committee with the support of the EORP Team. The
database will be located in the European Heart House, Les Templiers, 2035 route des Colles,
CS 80179 BIOT – 06903 SOPHIA ANTIPOLIS Cedex.

10.3.

Progress Status Reports

Database status and registry progress reports will be published on the website by the EORP
Team. Users may have different levels of access to this data depending on their role. This way,
all interested parties can obtain instant information on the survey status. Regular newslettersand recruitment rates will be provided to the centres.

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11. Statistical considerations and sample size
All the patients enrolled will be included in the analyses. Since this is an observational study,
descriptive summaries will be presented for all the patients, and for subgroups of patients.
Univariate analysis will be applied to both continuous and categorical variables. Continuous
variables will be reported as mean±SD or as median and Interquartile Range (IQR). Amonggroup comparisons will be made using a non-parametric test (Kruskal-Wallis test). Categoricalvariables will be reported as percentages. Among-group comparisons will be made using a chisquare test or Fisher’s Exact test if any expected cell count is less than five.
Multivariable analyses may be used to explore relationship between baseline covariates andpost-baseline endpoints, as appropriate. Considering the explorative and observational natureof the current study, no formal sample size calculation has been performed. However, theexpectation is to enroll around 2000 patients (considering the participation of around 30
countries).

12. Study organisation
12.1.

Oversight Committee

The entire EORP is managed and overseen by the EORP Oversight Committee whose main
responsibility stands at a strategic level. The Chairperson is a past ESC President and themembers are past/elect/current ESC Presidents, representative of the ESC Associations and/or
Working Groups and are listed in appendix 1.

12.2.

Executive Committee

The Executive Committee is composed of distinguished independent scientists andinvestigators of which some are representative of EACVI, VHD Working Group, and EORP. The
Executive Committee is responsible for:

Overall guidance of the Registry.



The design and writing of the study protocol and CRF, and for overseeing its
implementation.



Monitoring the progress of the study, being in direct contact with the National Coordinators(responsible for the performance of the national network) and the EORP coordinating
Department (responsible for the management of the study).

The members of the Executive Committee of the Infective Endocarditis registry are listed inappendix 2.

12.3.

Steering Committee

The steering committee is composed of the national Coordinators who will be responsible for:

Providing input to the protocol and Case Report Form

Participating in the publication plan definitionParticipating at the registry meetings.

Implementing the study in their country, in particular to:

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-

Inform the EORP team and the investigators of the Ethical and legal
requirements with regard to the registry in their country.

-

Translate the master patient informed consent form and any relevant documents
for review by the Ethics Committees and national authorities, if applicable.

-

Provide support to the centres for any necessary Ethics Committee submission.

-

Maintain continuous contacts with the investigators at national level.

-

Assist in ensuring quality control of national data.

12.4. European Society of Cardiology coordinating centre (EORP
Department)
The main coordinating centre is the EURObservational Research Programme of the ESC(EORP).
The EORP Team’s main role is to operationally coordinate the project, provide support to theCommittees, National Coordinators and participating centres and guard the methodologicalconcepts of the registry.
Specifically, the EORP Team has to assure the constant quality control and continuity,necessary to ensure that projects are completed on time and within budget.
The EORP coordinating centre is also responsible for the tasks related to the data management
activities of the study (i.e. holder of the study database, cleaning of the data, database lock)as well as for the statistical analyses.

12.5.

Investigator Centres

1 centre every 1 million of inhabitants (ranging from approximately 10 to 30 countries) are
anticipated to participate in the study. Depending on the number of patients seen in eachcentre per year, it is anticipated that between 10 and 20 patients will be recruited by eachcentre. Centres will be appointed by the Executive Committee in collaboration with the
National Imaging Community.

13. Duration of RegistryThis registry is intended to start in 2016. It is anticipated that approximately 2000 patients will
be enrolled yearly over a period of minimum 12 months.
There is no maximum number of patients per centre. The number of patients per centre, andnumber of centres involved in each country will be set up in advance in consultation with the
National Coordinators who will have knowledge of clinical practices, specific to each country.

14. Ethical issues
The National Coordinators chosen by the chairs of the registry and in conjunction with local
investigators/centres will be responsible for obtaining the approval of the local and/or national
Ethics Committees for this registry, if applicable.

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The EORP team will distribute the relevant documents in English to the National Coordinators,
who will be responsible thereafter for their translation and adaptation to their local regulations.
All patients will be approached by local centre investigators and will be asked for their written
informed consent to participate in the registry, if applicable.

14.1.

Protection of Human Subject

The EURO-ENDO EACVI/VHD Registry is an observational study that does not dictate themanner in which patients are evaluated or treated for IE. Physicians may decide to evaluate
and manage outpatients and inpatients with IE in the most appropriate way, according to the
local standard of care. There is no selection of patients and it is necessary to obtain patients’agreement.
In case of refusal, the patient will not be enrolled in the registry (if required by national laws or
regulations) and their data will not be collected.
Patients’ direct identifiable data will only be stored on local centre computers and not in the
EORP central database in order to facilitate subsequent follow-up of patients.
Collected Patients data will be strictly anonymous. Only a code will identify patients in the
database. Demographic data such as the age and gender will be collected. No other patient
identifiers will be collected.
In order to maintain strict security and ensure data validity, each investigator/study personnel
will have a unique login and password to enter patient’s information.
There will be no storage of clinical data outside of the data collection instrument, which will bea secure, web-based form. The main database will be secured according to current standards
to ensure both ethical and integrity requirements of the data.
Patients having died before giving informed consent may also be included, unless the local IRB
does not allow this procedure. Patients who cannot provide the informed consent at the time ofadmission in the cardiology ward due to very severe clinical conditions can give their consent
some hours/days after admission, when more favourable clinical conditions allow them toreceive the appropriate information.

15. Pharmacovigilance
Investigators are reminded to report any adverse drug reaction to the Competent Authorities
and/or to the Marketing Authorisation Holder of the concerned product, as requested in routine
clinical practice, according to the local routine pharmacovigilance rules.

16. Local monitoring
Periodically, the participating centres may be selected for auditing via on-site visits, which will
be performed by ad-hoc clinical research assistants, trained by the EORP team, in order toassess consecutiveness of enrolment and the reliability of key, pre-defined clinical variables,
via source documentation cross-checking.
The sites that will be monitored will be chosen on a risk-based strategy (e.g. number ofpatients enrolled, issues, high number of data management queries...).

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17. Publication Policy
Data will be published under the responsibility of the Executive Committee of the study.
Requests for further analyses to support ancillary publications must be submitted to the
Executive Committee for review and approval. Any publication of data collected as a result of
this study will be considered a joint publication by the investigator, Executive Committee
members and personnel of the Scientific Secretariat and Data Management team. Contributionof the author to the study design, enrolment, data review, and manuscript preparation andreview will be considered when determining the order of authorship. After the publication of
the main paper, the database is available for further analyses to all participating Investigators.
The Executive Committee must receive a copy of any presentation, manuscript, or abstractprior to dissemination according to the terms outlined in the protocol.
Participation of each centre will be acknowledged with their name reported on scientificpublications according to the EORP publication policy.

18. References
1. Wang A, Athan E, Pappas PA, Fowler VG, Jr., Olaison L, Pare C, Almirante B, Munoz P,
Rizzi M, Naber C, Logar M, Tattevin P, Iarussi DL, Selton-Suty C, Jones SB, Casabe J,
Morris A, Corey GR, Cabell CH. Contemporary clinical profile and outcome of prosthetic
valve endocarditis. JAMA 2007;297(12):1354-1361.
2. Habib G. Management of infective endocarditis. Heart 2006;92(1):124-130.
3. Heiro M, Helenius H, Hurme S, Savunen T, Metsarinne K, Engblom E, Nikoskelainen J,
Kotilainen P. Long-term outcome of infective endocarditis: a study on patients surviving
over one year after the initial episode treated in a Finnish teaching hospital during 25
years. BMC Infect Dis 2008;8:49.
4. Correa de Sa DD, Tleyjeh IM, Anavekar NS et al. Epidemiological trends of infective
endocarditis : a population-based study in Olmsted County, Minnoseta. May Clin Proc
2010; 85: 422-426.
5. Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG, Jr., Bayer AS, Karchmer AW,
Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falco V, Holland DJ, Jones P,
Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH.
Clinical presentation, etiology, and outcome of infective endocarditis in the 21st
century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch
Intern Med 2009;169(5):463-473.
6. Chu VH, Cabell CH, Benjamin DK, Jr., Kuniholm EF, Fowler VG, Jr., Engemann J, Sexton
DJ, Corey GR, Wang A. Early predictors of in-hospital death in infective endocarditis.
Circulation 2004;109(14):1745-1749.
7. San Roman JA, Lopez J, Vilacosta I, Luaces M, Sarria C, Revilla A, Ronderos R,
Stoermann W, Gomez I, Fernandez-Aviles F. Prognostic stratification of patients with
left-sided endocarditis determined at admission. Am J Med 2007;120(4):369-7.
8. Hoen B, Alla F, Selton-Suty C, et al. Changing profile of infective endocarditis: results ofa 1-year survey in France. Jama 2002;288:75-81.
9. Cabell CH, Jollis JG, Peterson GE, et al. Changing patient characteristics and the effecton mortality in endocarditis. Arch Intern Med 2002; 162: 90-4.
10. Lopez J, Revilla A, Vilacosta I, et al. Age-dependent profile of left-sided infective
endocarditis: a 3-center experience. Circulation 2010;121:892-7
11. Tornos P, Iung B, Permanyer-Miralda G, Baron G, Delahaye F, Gohlke-Barwolf C,
Butchart EG, Ravaud P, Vahanian A. Infective endocarditis in Europe: lessons from theEuro heart survey. Heart 2005;91(5):571-575.
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12. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, andtreatment of infective endocarditis (new version 2009): the Task Force on thePrevention, Diagnosis, and Treatment of Infective Endocarditis of the European Societyof Cardiology (ESC). Eur Heart J 2009;30:2369-413.
13. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari
R, Cosyns B, Fox K, Aakhus S. Recommendations for the practice of echocardiography
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Appendix 1:

Oversight Committee members

Roberto Ferrari, Chairperson



Fausto Pinto, President of the ESC

Panos Vardas, Past-President of the ESC



Jeroen Bax, President-Elect of the ESC

Angeles Alonso, Expert

Stephan Gielen, Representative EAPCR

Patrizio Lancellotti, Representative EACVICarina Blomström-Lundqvist, Representative EHRA

Franz Weidinger, Representative EAPCIFrank Ruschitzka, Representative HFA

Uwe Zeymer, Representative ACCA



Nikolaos Maniadakis, Health Economics Expert

Aldo P Maggioni, Scientific Coordinator for EORP

Luigi Tavazzi, Past-Chairman of the OC

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Appendix 2:

Executive Committee members

Gilbert Habib, Chair, EACVIPatrizio Lancellotti, Co-Chair, EACVI and ESC WG VHD

Erwan Donal, Executive Committee, EACVIBernard Cosyns, Executive Committee, EACVIBogdan A. Popescu, Executive Committee, EACVIBernard Iung, ESC WG VHDRaphael Rosenhek, ESC WG VHD

Bernard Prendegast, ESC WG VHD

Pilar Tornos, ESC WG VHDPaola Erba (Nuclear medicine, Pisa)



Aldo P Maggioni, Scientific Coordinator EORP

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