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Determinants of cerebral lesions in endocarditis on systematic cerebral magnetic resonance imaging: a prospective

Bernard Iung1, Sarah Tubiana, Isabelle Klein

  • 1From the Departments of Cardiology (B.I., D.M.-Z., E.B.), Biostatistic (S.T.), Radiology (I.K.), Cardiovascular Surgery (L.L., N.A.-A.), Microbiology (R.R.), Intensive Care (M.W.), and Infectious Disease (X.D.), AP-HP, Bichat Hospital, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France (B.I., R.R., C.L., M.W., X.D.); INSERM Clinical Investigation Center 007, Paris, France (S.T., X.D.); and INSERM U738, Paris, France (C.L., X.D.).

Stroke
|September 5, 2013
PubMed
Abstract

Insights

Cerebral lesions are common in infective endocarditis (IE). Larger vegetation length increases ischemic lesion risk, while prosthetic valve IE is linked to microbleeds, as shown by systematic brain MRI.

Area of Science:

  • Neurology
  • Cardiology
  • Infectious Diseases

Background:

  • Cerebral lesions are frequent complications of infective endocarditis (IE) with prognostic impact.
  • Cerebral MRI detects these lesions in many patients, but their determinants remain unclear.

Purpose of the Study:

  • To identify the determinants of cerebral lesions in patients with IE using systematic cerebral MRI.
  • To analyze factors associated with ischemic lesions and microbleeds.

Main Methods:

  • Prospective analysis of determinants of ischemic lesions and microbleeds.
  • Systematic cerebral MRI in 120 patients with left-sided IE.

Main Results:

  • Ischemic lesions were associated with vegetation length (OR 1.10/mm) and Staphylococcus aureus IE (OR 2.65).
  • Microbleeds were associated with prosthetic IE (OR 8.01) but not anticoagulant therapy.
  • MRI detected ischemic lesions in 53.3% and microbleeds in 60.0% of patients.

Conclusions:

  • Systematic cerebral MRI is highly sensitive for detecting ischemic lesions and microbleeds in acute IE.
  • Increased vegetation length significantly raises ischemic lesion risk.
  • Microbleeds are primarily associated with prosthetic valve IE.
Keywords:
echocardiographyendocarditismicrobleedsstroke

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