Related Experiment Video
Updated: May 5, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
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.
Insights
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.
Aims:
To analyse the risk of death according to the type of cerebrovascular complications (CVC) during infective endocarditis (IE) and to analyse the determinants of outcome in patients with IE and a CVC.
Methods And Results:
In two referral centres, 496 consecutive patients with definite IE were prospectively included. Cerebral CT scan was performed in 453 patients. During a mean 2.9 year follow-up, 139 (28%) patients died and CVC occurred in 109 (22%) patients. Stroke was an independent predictor of death, although no significant excess mortality was observed in patients with silent CVC or transient ischaemic attack (TIA). Among CVC patients, mortality was predicted by the presence of a mechanical prosthetic valve IE and a low Glasgow Coma Scale. When valvular surgery was performed in patients after CVC, neurologic exacerbation was rare [4 (6.3%) patients] and was observed only in patients with symptomatic stroke. Among CVC patients, survival was better in operated patients when compared with patients treated conservatively despite theoretical indication for surgery (P < 0.0001). However, the latter group had more comorbidities (P = 0.007) and a lower Glasgow Coma Scale (14.6 +/- 1 vs. 12 +/- 4, P < 0.0001).
Conclusion:
Patients with silent CVC or TIA have a relatively good prognosis, whereas those with stroke have significant excess mortality particularly in case of mechanical prosthetic valve IE or impaired consciousness. Valvular surgery can be safely performed after silent CVC or TIA and may improve survival in selected patients with stroke.
Related Concept Videos
01:25Endocarditis I: Introduction
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:18Endocarditis III: Medical Management
01:29Endocarditis IV: Nursing Management
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care