Neurological Complications of Infective Endocarditis

Sotero, Filipa Dourado; Rosário, Madalena; Fonseca, Ana Catarina; Ferro, José M.

doi:10.1007/s11910-019-0935-x

Cited by 51 publications

(41 citation statements)

References 47 publications

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“…The prevalence of IE ranges from 1.5 to 11.6 cases per 100 000 people around the world, and IE is associated with economic and medical conditions. IE may present many extra‐cardiac symptoms or signs, in which neurological complications are the most prominent and severe . The manifestations of neurological complications include ischemic stroke, hemorrhagic stroke, mycotic aneurysms, brain abscesses, meningitis, and encephalitis …”

Section: Introductionmentioning

confidence: 99%

High level of D‐dimer predicts ischemic stroke in patients with infective endocarditis

Wang

et al. 2020

Clinical Laboratory Analysis

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Background: Ischemic stroke is one of the most prominent and serious neurological complications of infective endocarditis (IE). Our study was designed to evaluate the predictive value of higher level of plasma D-dimer on admission for the development of ischemic stroke in patients with IE. Methods:In this prospective study, a total of 173 consecutive patients with IE were recruited from January 2016 to December 2018. Plasma D-dimer and other clinical indexes of IE patients were measured after admission. The number of patients who developed ischemic stroke during 6-month follow-up was recorded, as well as the occurrence time of ischemic stroke. Results:Ischemic stroke was observed in 38 (22%) patients during 6-month follow-up since definite diagnosis of IE. Patients with ischemic stroke had significantly higher levels of plasma D-dimer than those of patients without stroke (4982 vs 2205 μg/L, P < .001). In addition, Staphylococcus aureus infection (HR: 1.96, 95% CI: 1.51-2.42), mitral valve vegetation (HR: 1.52, 95% CI: 1.32-1.75), and higher levels of on-admission plasma D-dimer (HR: 1.35, 95% CI: 1.27-1.43) were significantly associated with ischemic stroke. Moreover, D-dimer levels ≥3393 μg/L served as a strong predictor for ischemic stroke in patients with IE, and the sensitivity and specificity were 78% and 83%, respectively. Conclusion:Our study suggested that higher level of D-dimer on admission was an independent predictor for ischemic stroke in patients with IE. These patients may require special attention, in particular within the first trimester after IE diagnosis. K E Y W O R D SD-dimer, infective endocarditis, ischemic stroke | INTRODUC TI ONInfective endocarditis (IE) is a life-threatening disease, especially in developing countries such as China. The prevalence of IE ranges from 1.5 to 11.6 cases per 100 000 people around the world, 1 and IE is associated with economic and medical conditions. IE may present many extra-cardiac symptoms or signs, in which neurological complications are the most prominent and severe. 2 The manifestations of neurological complications include ischemic stroke, hemorrhagic stroke, mycotic aneurysms, brain abscesses, meningitis, and encephalitis. 3 Xu and Fu contributed equally to this work.

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Section: Introductionmentioning

confidence: 99%

High level of D‐dimer predicts ischemic stroke in patients with infective endocarditis

Wang

et al. 2020

Clinical Laboratory Analysis

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“…Overall, almost half of the patients with stroke due to infective endocarditis treated with mechanical thrombectomy were functionally independent after 3 months. Many previous studies showed that the occurrence of neurologic complications during infective endocarditis were associated with an increased risk of mortality [1,2,4,27,28]. More specifically, Thuny et al [29] demonstrated that the risk of death differed according to the type of cerebrovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…Acute ischemic stroke is the most common neurological complication of infective endocarditis, manifesting clinically in 20-40% of the patients [1,2]. Conversely, complications may be completely silent as asymptomatic ischemia can occur in another 30-40% of patients [3].…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature

D’Anna

2020

Neurol Sci

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Background Mechanical thrombectomy is the standard of care, in selected patients, for acute ischemic stroke with large vessel occlusion but its use in patients with stroke secondary to infective endocarditis is controversial. We report three cases of acute ischemic stroke treated by mechanical thrombectomy and we propose an extensive review of the literature to evaluate the clinical safety and efficacy of thrombectomy in patients with stroke secondary to infective endocarditis. Methods A comprehensive literature search was performed following a pre-specified protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Case reports, cases series, cross-sectional studies, case control studies, randomized controlled trials or nonrandomized controlled trials were considered that included endocarditis-related acute ischemic stroke patients who underwent mechanical thrombectomy. Results The database search yielded 431 relevant records published until January 2020. Nineteen articles fulfilled the eligibility criteria that described thirty patients. After the thrombectomy, 13.3% of the patients experienced intracranial haemorrhage. After the procedure, the median National Institutes of Health Stroke Scale score dropped from 15 (IQR 7) to 2.5 (IQR 5.75). At 90 days, mortality was 23.3% while 46.7% of the patients were functionally independent (mRS ≤ 2). Discussion Based on our review, the use of mechanical thrombectomy in patients with large vessel occlusion due to endocarditisassociated stroke might improve patient outcome but it should be considered on a case by case base as the safety has not been well established yet. Further research on risk stratification is needed to drive clinician during the decision-making process.

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“…The number of patients admitted with intravenous drug-associated infectious endocarditis increased between 2008 and 2015, paralleling the increased use of mixed intravenous drugs 7 8. In turn, infectious endocarditis-derived neurological complications have also amplified and are largely responsible for poor outcomes in this patient population 8…”

Section: Discussionmentioning

confidence: 99%

“…These events can happen before, during, or after antibiotic therapy; however, the incidence drops after 2 or 3 weeks of successful treatment. The risk of emboli also rises as vegetations on the cardiac valves enlarge 7–9. Nevertheless, the individual risk and rate of septic emboli is still very difficult to predict.…”

Section: Discussionmentioning

confidence: 99%

Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis

et al. 2019

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Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation. Two adult patients with a history of intravenous drug use and one child with congenital heart disease are described. They were all diagnosed with infectious endocarditis and developed neurological symptoms during their hospital course. Initial catheter-based cerebral angiograms demonstrated vascular occlusions, which were followed by the development of MA at the same sites within 1 month. Septic emboli, documented on cerebral angiogram, in patients with infectious endocarditis may precede the appearance of MA. Patients with angiographic occlusions in the setting of endocarditis warrant close follow-up.

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Neurological Complications of Infective Endocarditis

Cited by 51 publications

References 47 publications

High level of D‐dimer predicts ischemic stroke in patients with infective endocarditis

High level of D‐dimer predicts ischemic stroke in patients with infective endocarditis

Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature

Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis

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