Journal
JOURNAL OF THE NEUROLOGICAL SCIENCES
Volume 442, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.jns.2022.120386
Keywords
Infective endocarditis; Stroke; Cerebrovascular diseases; Neuroimaging
Categories
Funding
- Andrew David Heitman Young Investigator Fund [1200-236980]
- National Institute of Neurological Disorders and Stroke [R25 NS065743]
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This study investigated the risk factors for different neurological complications in patients with left-sided infective endocarditis (IE), revealing associations between large vegetation size and stroke, mycotic aneurysms and intraparenchymal hemorrhage, as well as prosthetic valves and Staphylococcus aureus infection with cerebral microbleeds (CMB).
Background and purpose: Neurological complications following infective endocarditis (IE) directly contribute to long-term morbidity. We examined the risk factors for different neurological complications of left-sided IE. Methods: Using a database of consecutive adults admitted to a health system with left-sided IE from 2015 to 2019, the frequency of cerebral infarcts, intraparenchymal hemorrhage, cerebral microbleeds (CMB), mycotic aneurysm, and encephalopathy was determined. Variables with significant differences comparing each neurological complication (p < 0.1) were entered into regression models along with age to determine predictors. Results: 211 patients with mean age 54 (+/- 18) years, and 69 (33%) females were included. Infarcts were found in 118 (56%) patients, intraparenchymal hemorrhage was found in 17 (8%) patients, CMB were found in 58 (27%) patients, mycotic aneurysms were found in 22 (10%) patients, and encephalopathy occurred in 16 (8%) patients. In multivariable models, vegetation size >= 15 mm was associated with a higher risk of infarcts (aOR 2.26, 95% CI (1.12-4.57)), and the presence of a mycotic aneurysm was a risk factor for intraparenchymal hemorrhage (aOR 18.79, 95% CI (3.97-88.97)). Prosthetic valves (aOR 2.89, 95% CI (1.11-7.54)) and Staphylococcus aureus infection (aOR 3.50, 95% CI (1.08-11.36)) were associated with CMB. No risk factors emerged as predictors of encephalopathy. Conclusions: Large vegetation size is associated with stroke in patients with IE. Mycotic aneurysms are found at a higher frequency in young patients and are the primary cause of intraparenchymal hemorrhage. CMB may be related to prosthetic valves and Staphylococcus aureus infection.
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