Cor Vasa 2026, 68(1):8-15 | DOI: 10.33678/cor.2025.104

Speckle Tracking Echocardiography: The Secret Key To Predicting Poor Outcomes in Infective Endocarditis

Ahmed A. Elamragy, Juliette Bahgat Mesak, Wael Mohamed Elnaggar, Karim Said, Marwa Sayed Meshaal
Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt

Objectives: To investigate speckle-tracking echocardiography's role in detecting subclinical myocardial dysfunction in infective endocarditis (IE) patients and predicting in-hospital outcomes.

Methods: We prospectively enrolled 46 patients with active IE. Blood cultures and serology tests were performed, and blood samples for total leucocytic count, C-reactive protein (CRP), and procalcitonin were col- lected at multiple intervals. Serial conventional transthoracic echocardiography with speckle tracking was also performed.

Results: Most patients had right-sided IE linked to intravenous drug use. Despite preserved left ventricular ejection fraction (LVEF), all patients showed impaired global longitudinal strain (GLS) on admission. Poor outcomes correlated with significantly less negative GLS (p <0.001) and MRSA infection (p = 0.043). GLS on admission correlated with CRP, procalcitonin, and vegetation size. Higher improvement rates in procalcitonin, vegetation size, and GLS were seen in patients with favorable outcomes (p <0.001). GLS (p = 0.016, OR 28.97) and vegetation number (p = 0.029, OR 4.41) were significant predictors of poor outcomes. A GLS cut-off ≥-14.5% predicted poor outcomes with moderate sensitivity (76%) and specificity (65%) (AUC 0.75, p = 0.002).

Conclusion: Subclinical myocardial depression detected by GLS is common in IE patients, particularly those with complicated hospital courses. GLS and vegetation number on admission independently predict poor outcomes. An LV GLS >-14.5% can moderately predict in-hospital complications.

Keywords: Global longitudinal strain, Infective endocarditis, Speckle tracking echocardiography

Received: May 21, 2025; Revised: September 7, 2025; Accepted: October 5, 2025; Prepublished online: June 2, 2012; Published: March 15, 2026  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Elamragy AA, Mesak JB, Elnaggar WM, Said K, Meshaal MS. Speckle Tracking Echocardiography: The Secret Key To Predicting Poor Outcomes in Infective Endocarditis. Cor Vasa. 2026;68(1):8-15. doi: 10.33678/cor.2025.104.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009;169:463-473. Go to original source... Go to PubMed...
    2. McGowan JH, Cleland JGF. Reliability of reporting left ventricular systolic function by echocardiography: A systematic review of 3 methods. Am Heart J 2003;146:388-397. Go to original source...
    3. Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. J Am Coll Cardiol 2017;69:1043-1056. Go to original source... Go to PubMed...
    4. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J 2015;36:3075-3128. Go to original source... Go to PubMed...
    5. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-271. Go to original source... Go to PubMed...
    6. Tops LF, Delgado V, Marsan NA, Bax JJ. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail 2017;19:307-313. Go to original source... Go to PubMed...
    7. Lauridsen TK, Park L, Tong SYC, et al. Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis. Circ Cardiovasc Imaging 2015;8:1-9. Go to original source... Go to PubMed...
    8. Mi MY, Nelson SB, Weiner RB. Clinical and Echocardiographic Factors Associated With In-Hospital Mortality in Patients With Infective Endocarditis Affecting the Native Tricuspid Valve. Am J Cardiol 2016;118:739-743. Go to original source... Go to PubMed...
    9. Dandel M, Lehmkuhl H, Knosalla C, et al. Strain and Strain Rate Imaging by Echocardiography - Basic Concepts and Clinical Applicability. Curr Cardiol Rev 2009;5:133-148. Go to original source... Go to PubMed...
    10. Dalla K, Hallman C, Bech-Hanssen O, et al. Strain echocardiography identifies impaired longitudinal systolic function in patients with septic shock and preserved ejection fraction. Cardiovasc Ultrasound 2015;13:30. Go to original source... Go to PubMed...
    11. Ng PY, Sin WC, Ng AKY, Chan WM. Speckle tracking echocardiography in patients with septic shock: a case control study (SPECKSS). Crit Care 2016;20:145. Go to original source... Go to PubMed...
    12. Basu S, Frank LH, Fenton KE, et al. Two-dimensional speckle tracking imaging detects impaired myocardial performance in children with septic shock, not recognized by conventional echocardiography. Pediatr Crit Care Med 2012;13: 259-264. Go to original source... Go to PubMed...
    13. Zampino R, Marrone A, Restivo L, et al. Chronic HCV infection and inflammation: Clinical impact on hepatic and extra-hepatic manifestations. World J Hepatol 2013;5:528. Go to original source... Go to PubMed...
    14. Adinolfi LE. Chronic hepatitis C virus infection and atherosclerosis: Clinical impact and mechanisms. World J Gastroenterol 2014;20:3410. Go to original source... Go to PubMed...
    15. Nevola R, Acierno C, Pafundi PC, Adinolfi LE. Chronic hepatitis C infection induces cardiovascular disease and type 2 diabetes: mechanisms and management. Minerva Med 2021;112: 188-200. Go to original source... Go to PubMed...
    16. Lauridsen TK, Alhede C, Crowley AL, et al. Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis. Int J Cardiol 2018;260:118-123. Go to original source... Go to PubMed...
    17. De Geer L, Engvall J, Oscarsson A. Strain echocardiography in septic shock - a comparison with systolic and diastolic function parameters, cardiac biomarkers and outcome. Crit Care. 2015;19:122. Go to original source...
    18. Dalen H, Thorstensen A, Aase SA, et al. Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: The HUNT study in Norway. Eur J Echocardiogr 2010;11:176-183. Go to original source... Go to PubMed...
    19. Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH. Normal ranges of left ventricular strain: A meta-analysis. J Am Soc Echocardiogr 2013;26:185-191. Go to original source... Go to PubMed...
    20. Capotosto L, Ciardi M, Tanzilli G, et al. Abstract 323: Three-dimensional Transesophageal Echocardiography and Speckle Tracking Echocardiography in Infective Aortic Endocarditis: Analysis of Parameters Predictors of Outcome. Circulation 2020;142(Suppl_4). Go to original source...
    21. Rizk HH, Elamragy AA, Youssef GS, et al. Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility. Egypt Heart J 2019;71:17. Go to original source... Go to PubMed...
    22. Stavi V, Brandstaetter E, Sagy I, et al. Comparison of Clinical Characteristics and Prognosis in Patients with Right- and Left-sided Infective Endocarditis. Rambam Maimonides Med J 2019;10:e0003. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content