Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography

Thuny, Franck; DiSalvo, Giovanni; Belliard, Olivier; Aviérinos, Jean-François; Pergola, Valeria; Rosenberg, Valerie; Casalta, Jean‐Paul; Gouvernet, Joanny; Dérumeaux, Geneviève; Iarussi, D; Ambrosi, Pı̈erre; Calabrò, R; Ribéri, Alberto; Collart, Frédéric; Métras, D; Lépidi, Hubert; Raoult, Didier; Harlé, Jean‐Robert; Weiller, Pierre‐Jean; Cohen, Ariel; Habib, Gilbert

doi:10.1161/circulationaha.104.493155

Cited by 609 publications

(368 citation statements)

References 42 publications

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“…Based on data from a nationwide inpatient sample (NIS) in the United States, the incidence of IE was calculated to increase from 11.4 per 100,000 person-years in 1999 to 16.6 per 100,000 person-years in 2006 (131), with most of the increase in incidence being driven by an increase in the incidence of S. aureus IE. S. aureus IE was also associated with increased mortality compared to other causative pathogens, a finding in keeping with most contemporary studies (125,(132)(133)(134)(135). In a separate analysis of this NIS data set, the incidence of IE increased from 9.3 per 100,000 person-years in 1998 to 12.7 per 100,000 person-years in 2009.…”

Section: Epidemiologysupporting

confidence: 85%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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Section: Epidemiologysupporting

confidence: 85%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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“…Our findings suggest that inflammatory reactions may play an important role in ischemic lesion development in IE patients. Causative organisms, such as S. aureus [3,16,23], and vegetation length [23,24,25,26] were reported as risk factors for acute ischemic lesion development by several previous studies. However, we found no relationship between these factors and acute ischemic lesions.…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Brain Lesions in Infective Endocarditis: Incidence, Related Factors, and Postoperative Outcome

et al. 2013

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Background: Acute brain infarction affects the timing and regimen of cardiac surgery in patients with infective endocarditis (IE). We aimed to identify preoperative brain MRI characteristics, incidence, and related factors for acute ischemic lesions in left-sided IE patients undergoing cardiac surgery. Furthermore, we investigated whether preoperative acute ischemic lesions are associated with postoperative neurological complications in IE patients. Methods: We retrospectively reviewed consecutive patients with a definite left-sided IE who underwent cardiac surgery in 6 university-affiliated hospitals from January 2004 to November 2011. Preoperative brain MRI evaluations were systematically performed on all patients without contraindications, regardless of neurological complications, with the aim of preventing perioperative complications. Patients were included if diffusion-weighted imaging and fluid-attenuated inversion recovery sequences were performed within 14 days after diagnosis. Associations between acute ischemic lesions and related factors were analyzed. Neurological complications within 30 days after surgery were evaluated for postoperative outcome analyses. Results: Of 139 consecutive patients with left-sided IE who underwent cardiac surgery, 85 patients were evaluated in this study. The mean age was 58 ± 16 years, and 22 patients (26%) were women. Preoperative MRI revealed acute ischemic lesions in 47 patients (55%), and 19 of these patients developed neurological symptoms. Among the patients with ischemic lesions, 24 (60%) had small lesions (<10 mm), 36 (77%) had multiple lesions, and 30 (64%) had lesions in multiple vascular territories. Compared to patients without ischemic lesions, patients with acute ischemic lesions were older and had significantly higher white blood cell counts and plasma C-reactive protein (CRP) levels, but lower hemoglobin levels. Logistic regression analyses showed that the white blood cell count and plasma CRP level were independently associated with acute ischemic lesions [adjusted OR per 1-SD increase were 2.21 (95% CI: 1.23-4.35) and 2.33 (95% CI: 1.27-4.96), respectively]. Three patients developed postoperative neurological complications, but preoperative acute ischemic lesions and postoperative complications were not associated. Conclusions: Preoperative MRI detected a high incidence of asymptomatic ischemic lesions in IE patients. Acute ischemic lesions were often small, multiple, and located in multiple vascular territories. Inflammatory reactions may play an important role in the development of ischemic lesions in IE patients.

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“…Recent reports have highlighted the existence of asymptomatic cerebral lesions in patients with IE as revealed by systematic cerebral CT scans [10,11]. The impact of such asymptomatic lesions, as detected by CT scans, on prognosis is only partially known [12].…”

Section: Introductionmentioning

confidence: 99%

Infective Endocarditis with Symptomatic Cerebral Complications: Contribution of Cerebral Magnetic Resonance Imaging

et al. 2013

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Background: Cerebral complications are well-identified causes of morbidity and mortality in patients with infective endocarditis (IE). Few studies have analysed the impact of brain magnetic resonance imaging (MRI) in IE patients with neurological manifestations. Objectives: The aims of this study were to assess the MRI contribution to the management of patients with IE neurological manifestations and to compare cerebral CT and MRI findings. Material and Methods: Patients with definite or probable IE and neurological manifestations were prospectively enrolled from 2005 to 2008, in a university hospital (Bichat Claude Bernard Hospital, Paris). Clinical and radiological characteristics and echocardiographic findings were systematically recorded. Brain MRI with angiography was performed and compared to available CT scans. The contribution of MRI results to cerebral involvement staging and to therapeutic plans was evaluated. Results: Thirty patients, 37-89 years old, were included. Nineteen suffered from pre-existing heart disease. Blood cultures were positive in 29 cases and the main micro-organisms were streptococci (n = 14) and staphylococci (n = 13). The IE was mainly located on mitral (n = 15) and aortic valves (n = 13). Neurological events were strokes (n = 12), meningitis (n = 5), seizures (n = 1), impaired consciousness (n = 11) and severe headache (n = 1). MRI findings included ischaemic lesions (n = 25), haemorrhagic lesions (n = 2), subarachnoid haemorrhage (n = 5), brain abscess (n = 6), mycotic aneurysm (n = 7), vascular occlusion (n = 3) and cerebral microbleeds (n = 17). In 19/30 cases, neurological manifestations were observed before the diagnosis of IE. MRI was more sensitive than CT scan in detecting both clinically symptomatic cerebral lesions (100 and 81%, respectively) and additional asymptomatic lesions (50 and 23%, respectively). Therapeutic plans were modified according to MRI results in 27% of patients: antibiotherapy regimen modifications in 7% (switch for molecules with high cerebral diffusion) and surgical plan modifications in 20% (indication of valvular replacement due to the embolic nature of the vegetations revealed by MRI or postponement of surgery due to haemorrhagic lesions). None of the 16/30 (51%) operated-on patients experienced postoperative neurological worsening. In-hospital death occurred in 4 patients. Conclusion: In patients with IE neurological manifestations, MRI revealed a broader involvement of the brain (type and number of lesions) than indicated by clinical signs and/or CT scan. With a better disease staging of neurological manifestations, MRI brain imaging may help in patient management and the decision-making process especially for cardiac surgery indication and timing of valve replacement.

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Risk of Embolism and Death in Infective Endocarditis: Prognostic Value of Echocardiography

Cited by 609 publications

References 42 publications

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Acute Ischemic Brain Lesions in Infective Endocarditis: Incidence, Related Factors, and Postoperative Outcome

Infective Endocarditis with Symptomatic Cerebral Complications: Contribution of Cerebral Magnetic Resonance Imaging

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