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Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a
Franck Thuny1, Jean-François Avierinos, Christophe Tribouilloy
1Department of Cardiology, Hôpital de La Timone, Boulevard Jean Moulin, 13005 Marseille, France.
European Heart Journal
|March 17, 2007
Summary
Patients with infective endocarditis (IE) and cerebrovascular complications (CVC) face varying risks. Stroke indicates higher mortality, while silent CVC or TIA suggest a better prognosis, with surgery potentially improving outcomes.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious infection with potential cerebrovascular complications (CVC).
- Understanding the prognostic impact of different CVC types in IE is crucial for patient management.
Purpose of the Study:
- To analyze mortality risk associated with various CVC types in IE patients.
- To identify determinants of outcomes in IE patients experiencing CVC.
Main Methods:
- Prospective study of 496 IE patients across two centers.
- Cerebral CT scans performed in 453 patients; mean follow-up of 2.9 years.
- Analysis of mortality predictors and outcomes based on CVC type and treatment.
Main Results:
- CVC occurred in 22% of patients; 28% died during follow-up.
- Stroke was an independent predictor of death; silent CVC or TIA showed no significant excess mortality.
- Mortality in CVC patients was linked to mechanical prosthetic valve IE and low Glasgow Coma Scale; surgery improved survival.
Conclusions:
- Silent CVC or TIA in IE patients carries a good prognosis.
- Stroke significantly increases mortality, especially with mechanical prosthetic valves or impaired consciousness.
- Valvular surgery is safe after silent CVC/TIA and may benefit selected stroke patients.
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