Abstract
Heart failure complications in infective endocarditis (IE) are mainly due to acute valvular regurgitation secondary to valve destruction. The pathophysiology of acute AR accounts for particularities in clinical and echocardiographic presentation which may represent diagnostic pitfalls. Acute regurgitations are poorly tolerated due to the lack of left ventricular adaptation. Heart failure occurs in approximately a third of patients with IE and is strongly associated with an increase in early and late mortality. Despite the lack of randomized trials, a large body of evidence shows that early surgery improves the prognosis of patients with heart failure, as attested by guidelines. However, decision-making is difficult during acute IE and it is likely that certain patients with IE and heart failure are denied surgery without appropriate risk-benefit analysis. Heart failure after the acute phase of IE also has a negative prognostic impact and highlights the need for careful follow-up.
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