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Open Access 01-12-2024 | Stroke | Research article

Characteristics associated with occurrence of stroke in patients with infective endocarditis – a retrospective cohort study

Authors: H. Schuermann, R. von Rennenberg, C. Riegler, I. Rangus, S. Litmeier, J. F. Scheitz, W. Doehner, H. Audebert, T. B. Braemswig, C. H. Nolte

Published in: Neurological Research and Practice | Issue 1/2024

Abstract

Background

Stroke is a severe complication of infective endocarditis (IE), associated with high rates of mortality. Data on how IE patients with and without stroke differ may help to improve understanding contributing mechanisms.

Methods

All patients treated for IE between 2019 and 2021 with and without associated stroke were identified from the medical records of three academic tertiary care hospitals in Germany, all part of Charité – Universitätsmedizin Berlin, Germany. Multivariable logistic regression analyses were performed to identify variables associated with the occurrence of stroke.

Results

The study population consisted of 353 patients diagnosed with IE. Concomitant stroke occurred in 96/353 (27.2%) patients. Acute stroke was independently associated with co-occurring extracerebral arterial embolism [adjusted Odds ratio (aOR = 2.52; 95% confidence interval (CI) 1.35–4.71)], acute liver failure (aOR = 2.62; 95% CI 1.06–6.50), dental focus of infection (aOR = 3.14; 95% CI 1.21–8.12) and left-sided IE (aOR = 28.26; 95% CI 3.59-222.19). Stroke was found less often in IE patients with congenital heart disease (aOR = 0.20; 95% CI 0.04–0.99) and atypical pathogens isolated from blood culture (aOR = 0.31; 95% CI 0.14–0.72).

Conclusions

Stroke is more likely to occur in individuals with systemic complications affecting other organs, too. Special attention should be addressed to dental status. The low incidence of stroke in patients with congenital heart disease may reflect awareness and prophylactic measures.

Chen, H., Zhan, Y., Zhang, K., et al. (2022). The Global, Regional, and National Burden and trends of Infective Endocarditis from 1990 to 2019: Results from the global burden of Disease Study 2019. Front Med, 9, 774224. https://doi.org/10.3389/fmed.2022.774224.CrossRef

Feigin, V. L., Stark, B. A., Johnson, C. O., et al. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the global burden of Disease Study 2019. The Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0.CrossRef

Liesenborghs, L., Meyers, S., Lox, M., et al. (2019). Staphylococcus aureus endocarditis: Distinct mechanisms of bacterial adhesion to damaged and inflamed heart valves. European Heart Journal, 40(39), 3248–3259. https://doi.org/10.1093/eurheartj/ehz175.CrossRefPubMedPubMedCentral

Sonneville, R., Mirabel, M., Hajage, D., et al. (2011). Neurologic complications and outcomes of infective endocarditis in critically ill patients: The ENDOcardite en REAnimation prospective multicenter study*. Critical Care Medicine, 39(6), 1474–1481. https://doi.org/10.1097/CCM.0b013e3182120b41.CrossRefPubMed

García-Cabrera, E., Fernández-Hidalgo, N., Almirante, B., et al. (2013). Neurological complications of infective endocarditis: Risk factors, Outcome, and impact of cardiac surgery: A Multicenter Observational Study. Circulation, 127(23), 2272–2284. https://doi.org/10.1161/CIRCULATIONAHA.112.000813.CrossRefPubMed

del Val, D., Abdel-Wahab, M., Mangner, N., et al. (2021). Stroke complicating infective endocarditis after Transcatheter aortic valve replacement. Journal of the American College of Cardiology, 77(18), 2276–2287. https://doi.org/10.1016/j.jacc.2021.03.233.CrossRefPubMed

Deprèle, C., Berthelot, P., Lemetayer, F., et al. (2004). Risk factors for systemic emboli in infective endocarditis. Clinical Microbiology and Infection, 10(1), 46–53. https://doi.org/10.1111/j.1469-0691.2004.00735.x.CrossRefPubMed

Cabell, C. H., Pond, K. K., Peterson, G. E., et al. (2001). The risk of stroke and death in patients with aortic and mitral valve endocarditis. American Heart Journal, 142(1), 75–80. https://doi.org/10.1067/mhj.2001.115790.CrossRefPubMed

Habib, G., Lancellotti, P., Antunes, M. J., et al. (2015). 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-thoracic surgery (EACTS), the European Association of Nuclear Medicine (EANM). European Heart Journal, 36(44), 3075–3128. https://doi.org/10.1093/eurheartj/ehv319.CrossRefPubMed

10.

Braemswig, T. B., Usnich, T., Albach, F. N., et al. (2013). Early New Diffusion-Weighted Imaging lesions Appear more often in stroke patients with a multiple territory lesion pattern. Stroke, 44(8), 2200–2204. https://doi.org/10.1161/STROKEAHA.111.000810.CrossRefPubMed

11.

Endres, M., Moro, M. A., Nolte, C. H., Dames, C., Buckwalter, M. S., & Meisel, A. (2022). Immune pathways in Etiology, Acute Phase, and chronic sequelae of ischemic stroke. Circ Res, 130(8), 1167–1186. https://doi.org/10.1161/CIRCRESAHA.121.319994.CrossRefPubMed

12.

Baddour, L. M., Wilson, W. R., Bayer, A. S., et al. (2015). Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A Scientific Statement for Healthcare professionals from the American Heart Association. Circulation, 132(15), 1435–1486. https://doi.org/10.1161/CIR.0000000000000296.CrossRefPubMed

13.

Vincent, L. L., & Otto, C. M. (2018). Infective endocarditis: Update on Epidemiology, outcomes, and management. Current Cardiology Reports, 20(10), 86. https://doi.org/10.1007/s11886-018-1043-2.CrossRefPubMed

14.

Murdoch, D. R. (2009). Clinical presentation, etiology, and Outcome of Infective endocarditis in the 21st Century: The international collaboration on endocarditis–prospective cohort study. Archives of Internal Medicine, 169(5), 463. https://doi.org/10.1001/archinternmed.2008.603.CrossRefPubMedPubMedCentral

15.

Cahill, T. J., Prendergast, B. D., & Infective endocarditis (2016). Lancet.;387(10021):882–893. doi:https://doi.org/10.1016/S0140-6736(15)00067-7.CrossRefPubMed

16.

Yumoto, H., Hirota, K., Hirao, K., et al. (2019). The pathogenic factors from oral streptococci for systemic diseases. IJMS, 20(18), 4571. https://doi.org/10.3390/ijms20184571.CrossRefPubMedPubMedCentral

17.

Jiang, Q., Zhou, X., Cheng, L., & Li, M. (2019). The Adhesion and Invasion mechanisms of Streptococci. Current Issues in Molecular Biology, 32, 521–560. https://doi.org/10.21775/cimb.032.521.CrossRefPubMed

18.

Carinci, F., Martinelli, M., Contaldo, M., et al. (2018). Focus on periodontal disease and development of endocarditis. Journal of Biological Regulators and Homeostatic Agents, 32(2 Suppl. 1), 143–147.PubMed

19.

Abranches, J., Zeng, L., Kajfasz, J. K. (2018). Biology of Oral Streptococci. Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Braunstein M, Rood JI, eds. Microbiol Spectr.;6(5):6.5.11. https://doi.org/10.1128/microbiolspec.GPP3-0042-2018.

20.

Thuny, F., Grisoli, D., Collart, F., Habib, G., & Raoult, D. (2012). Management of infective endocarditis: Challenges and perspectives. The Lancet, 379(9819), 965–975. https://doi.org/10.1016/S0140-6736(11)60755-1.CrossRef

21.

Dickerman, S. A., Abrutyn, E., Barsic, B., et al. (2007). The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: An analysis from the ICE prospective Cohort Study (ICE-PCS). American Heart Journal, 154(6), 1086–1094. https://doi.org/10.1016/j.ahj.2007.07.023.CrossRefPubMed

22.

Baddour, L. M., Shafiyi, A., Lahr, B. D. (2021). A Contemporary Population-Based Profile of Infective Endocarditis Using the Expanded Rochester Epidemiology Project. Mayo Clinic Proceedings.;96(6):1438–1445. https://doi.org/10.1016/j.mayocp.2020.08.044.

23.

Hoen, B. (2002). Changing Profile of Infective EndocarditisResults of a 1-Year survey in France. Journal of the American Medical Association, 288(1), 75. https://doi.org/10.1001/jama.288.1.75.CrossRefPubMed

24.

Altersberger, V. L., Stolze, L. J., Heldner, M. R., et al. (2021). Maintenance of Acute Stroke Care Service during the COVID-19 pandemic lockdown. Stroke, 52(5), 1693–1701. https://doi.org/10.1161/STROKEAHA.120.032176.CrossRefPubMedPubMedCentral

25.

Erdur, H., Siegerink, B., Leithner, C., et al. (2021). Stroke admissions, stroke severity, and Treatment Rates in Urban and Rural Areas during the COVID-19 pandemic. Frontiers in Neurology, 11, 607193. https://doi.org/10.3389/fneur.2020.607193.CrossRefPubMedPubMedCentral

Title: Characteristics associated with occurrence of stroke in patients with infective endocarditis – a retrospective cohort study
Authors: H. Schuermann
R. von Rennenberg
C. Riegler
I. Rangus
S. Litmeier
J. F. Scheitz
W. Doehner
H. Audebert
T. B. Braemswig
C. H. Nolte
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Stroke
Endocarditis
Acute Liver Failure
Artificial Heart Valve
Artificial Heart Valve
Artificial Heart Valve
Published in: Neurological Research and Practice / Issue 1/2024
Electronic ISSN: 2524-3489
DOI: https://doi.org/10.1186/s42466-024-00317-4

At a glance: The STEP trials

Springer Medicine

Characteristics associated with occurrence of stroke in patients with infective endocarditis – a retrospective cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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