Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2014

Open Access 01-12-2014 | Research article

Clinical significance of cerebrovascular complications in patients with acute infective endocarditis: a retrospective analysis of a 12-year single-center experience

Authors: Seung-Jae Lee, Sam-Sae Oh, Dal-Soo Lim, Chan-Young Na, Jae-Hyun Kim

Published in: BMC Neurology | Issue 1/2014

Login to get access

Abstract

Background

Cerebrovascular complications (CVCs) frequently occur in patients with acute infective endocarditis (IE). The aim of this study is to describe the clinical findings of CVCs and to evaluate the impact of CVCs on long-term mortality in patients with IE.

Methods

We retrospectively analyzed 144 patients who fulfilled the modified Duke’s criteria for definite left-sided IE. CVCs were classified into minor (silent cerebral embolism, TIA and stroke with an initial modified Rankin scale ≤ 2) or major (an initial modified Rankin scale ≥ 3) CVCs. Cox proportional hazards model was used for mortality analysis. Hazard ratio (HR) and 95% confidence interval (CI) were obtained.

Results

The mean age of the 144 patients (96 males and 48 females) was 49.1 years (range 6-85 years). A CVC was found in 37 (25.7%) patients. Of these, 25 were treated with surgical therapy. The patients who underwent early surgery within 2 weeks after stroke had a statistical trend toward a higher risk of postoperative brain hemorrhage (50% versus 4.8%, P = 0.057 by Fisher exact test). The minor CVC group had a similar risk of death as the no-CVC group (P = 0.803; HR 0.856; CI 0.253-2.894), whereas the major CVC group had a higher mortality (P = 0.013; HR 2.865; CI 1.254-6.548) than the no-CVC group. In the multivariate analysis, major CVC (P = 0.002; HR 3.893; CI 1.649-9.194) was a significant predictor of mortality in IE patients, together with advanced age (P = 0.005; HR 3.138; CI 1.421-6.930) and prosthetic valve IE (P = 0.008; HR 2.819; CI 1.315-6.044).

Conclusions

IE can give rise to various forms of CVC, most frequently, acute ischemic brain lesions. In our study, major CVC was associated with high risk of mortality although total CVC was not significantly related to the risk of death in patients with IE.
Appendix
Available only for authorised users
Literature
1.
Sonneville R, Mourvillier B, Bouadma L, Wolff M: Management of neurological complications of infective endocarditis in ICU patients. Ann Intensive Care. 2011, 1: 10-10.1186/2110-5820-1-10.CrossRefPubMedPubMedCentral
2.
Mourvillier B, Trouillet JL, Timsit JF, Baudot J, Chastre J, Régnier B, Gibert C, Wolff M: Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients. Intensive Care Med. 2004, 30: 2046-2052. 10.1007/s00134-004-2436-9.CrossRefPubMed
3.
Sonneville R, Mirabel M, Hajage D, Tubach F, Vignon P, Perez P, Lavoué S, Kouatchet A, Pajot O, Mekontso Dessap A, Tonnelier JM, Bollaert PE, Frat JP, Navellou JC, Hyvernat H, Hssain AA, Tabah A, Trouillet JL, Wolff M, ENDOcardite en REAnimation Study Group: Neurologic complications and outcomes of infective endocarditis in critically ill patients: the ENDOcardite en REAnimation prospective multicenter study. Crit Care Med. 2011, 39: 1474-1481. 10.1097/CCM.0b013e3182120b41.CrossRefPubMed
4.
Ruttmann E, Willeit J, Ulmer H, Chevtchik O, Höfer D, Poewe W, Laufer G, Müller LC: Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke. 2006, 37: 2094-2099. 10.1161/01.STR.0000229894.28591.3f.CrossRefPubMed
5.
Thuny F, Avierinos JF, Tribouilloy C, Giorgi R, Casalta JP, Milandre L, Brahim A, Nadji G, Riberi A, Collart F, Renard S, Raoult D, Habib G: Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study. Eur Heart J. 2007, 28: 1155-1161. 10.1093/eurheartj/ehm005.CrossRefPubMed
6.
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Ryan T, Bashore T, Corey GR: Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000, 30: 633-638. 10.1086/313753.CrossRefPubMed
7.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40: 373-383. 10.1016/0021-9681(87)90171-8.CrossRefPubMed
8.
Tatu L, Moulin T, Bogousslavsky J, Duvernoy H: Arterial territories of the human brain: brainstem and cerebellum. Neurology. 1996, 47: 1125-1135. 10.1212/WNL.47.5.1125.CrossRefPubMed
9.
Tatu L, Moulin T, Bogousslavsky J, Duvernoy H: Arterial territories of the human brain: cerebral hemisphere. Neurology. 1998, 50: 1699-1708. 10.1212/WNL.50.6.1699.CrossRefPubMed
10.
Ringelstein EB, Stogbauer F: Border zone infarcts. Stroke Syndromes. Edited by: Bogousslavsky J, Caplan L. 2001, New York: Cambridge University Press, 564-582. 2CrossRef
11.
Wong KS, Gao S, Chan YL, Hansberg T, Lam WW, Droste DW, Kay R, Ringelstein EB: Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol. 2002, 52: 74-81. 10.1002/ana.10250.CrossRefPubMed
12.
Singhal AB, Topcuoglu MA, Buonanno FS: Acute ischemic stroke patterns in infective and nonbacterial thrombotic endocarditis: a diffusion-weighted magnetic resonance imaging study. Stroke. 2002, 33: 1267-1273. 10.1161/01.STR.0000015029.91577.36.CrossRefPubMed
13.
Anderson DJ, Goldstein LB, Wilkinson WE, Corey GR, Cabell CH, Sanders LL, Sexton DJ: Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis. Neurology. 2003, 61: 1341-1346. 10.1212/01.WNL.0000094359.47929.E4.CrossRefPubMed
14.
Okazaki S, Yoshioka D, Sakaguchi M, Sawa Y, Mochizuki H, Kitagawa K: Acute ischemic brain lesions in infective endocarditis: incidence, related factors, and postoperative outcome. Cerebrovasc Dis. 2013, 35: 155-162. 10.1159/000346101.CrossRefPubMed
15.
Duval X, Iung B, Klein I, Brochet E, Thabut G, Arnoult F, Lepage L, Laissy JP, Wolff M, Leport C, IMAGE (Resonance Magnetic Imaging at the Acute Phase of Endocarditis) Study Group: Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med. 2010, 152: 497-504. 10.7326/0003-4819-152-8-201004200-00006.CrossRefPubMed
16.
Snygg-Martin U, Gustafsson L, Rosengren L, Alsiö A, Ackerholm P, Andersson R, Olaison L: Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers. Clin Infect Dis. 2008, 47: 23-30. 10.1086/588663.CrossRefPubMed
17.
Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falcó V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH, International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators: 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. 10.1001/archinternmed.2008.603.CrossRefPubMedPubMedCentral
18.
Fowler VG, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS, ICE Investigators: Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005, 293: 3012-3021. 10.1001/jama.293.24.3012.CrossRefPubMed
19.
Lepur D, Barsić B: Incidence of neurological complications in patients with native-valve infective endocarditis and cerebral microembolism: an open cohort study. Scand J Infect Dis. 2009, 41: 708-713. 10.1080/00365540903146995.CrossRefPubMed
20.
Derex L, Bonnefoy E, Delahaye F: Impact of stroke on therapeutic decision making in infective endocarditis. J Neurol. 2010, 257: 315-321. 10.1007/s00415-009-5364-3.CrossRefPubMed
21.
Angstwurm K, Borges AC, Halle E, Schielke E, Einhäupl KM, Weber JR: Timing the valve replacement in infective endocarditis involving the brain. J Neurol. 2004, 251: 1220-1226. 10.1007/s00415-004-0517-x.CrossRefPubMed
22.
Byrne JG, Rezai K, Sanchez JA, Bernstein RA, Okum E, Leacche M, Balaguer JM, Prabhakaran S, Bridges CR, Higgins RS: Surgical management of endocarditis: the society of thoracic surgeons clinical practice guideline. Ann Thorac Surg. 2011, 91: 2012-2019. 10.1016/j.athoracsur.2011.01.106.CrossRefPubMed
23.
Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, Casabé JH, Chu VH, Delahaye F, Edathodu J, Fortes CQ, Olaison L, Pangercic A, Patel M, Rudez I, Tamin SS, Vincelj J, Bayer AS, Wang A, International Collaboration on Endocarditis–Prospective Cohort Study Investigators: Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis. 2013, 56: 209-217. 10.1093/cid/cis878.CrossRefPubMed
24.
Yoshioka D, Sakaguchi T, Yamauchi T, Okazaki S, Miyagawa S, Nishi H, Yoshikawa Y, Fukushima S, Saito S, Sawa Y: Impact of early surgical treatment on postoperative neurologic outcome for active infective endocarditis complicated by cerebral infarction. Ann Thorac Surg. 2012, 94: 489-495. 10.1016/j.athoracsur.2012.04.027.CrossRefPubMed
Metadata
Title
Clinical significance of cerebrovascular complications in patients with acute infective endocarditis: a retrospective analysis of a 12-year single-center experience
Authors
Seung-Jae Lee
Sam-Sae Oh
Dal-Soo Lim
Chan-Young Na
Jae-Hyun Kim
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2014
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-14-30

Other articles of this Issue 1/2014

BMC Neurology 1/2014 Go to the issue

Research article

Response to cholinesterase inhibitors affects lifespan in Alzheimer's disease

Debate

Moving beyond anti-amyloid therapy for the prevention and treatment of Alzheimer’s disease

Research article

Clinical factors associated with statins prescription in acute ischemic stroke patients: findings from the Lombardia Stroke Registry

Research article

Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke

Research article

NQO1gene rs1800566 variant is not associated with risk for multiple sclerosis

Research article

Exome sequencing reveals a novel TTC19 mutation in an autosomal recessive spinocerebellar ataxia patient