Stroke in Patients with Infective Endocarditis: A 15-Year Single-Center Cohort Study

To explore the relationship between infective endocarditis (IE) and stroke.

The clinical data of patients diagnosed with IE from January 2003 to December 2017 in Beijing Anzhen Hospital Affiliated to Capital Medical University were retrospectively analyzed.

A total of 861 patients (mean age: 40.79 ± 16.27 [SD]) with IE was recruited. Vegetations were confirmed in 97.32% of all the patients, among whom 296 were diagnosed with congenital heart disease and another 53 with rheumatic valvular disease. The most common pathogens were Streptococcus, Staphylococcus, and various types of fungi (13.12, 7.31, and 1.16% respectively). Out of the 138 patients diagnosed with stroke, 101 cases were of ischemic stroke, 23 cases were of hemorrhagic stroke, and 12 cases were of concurrent ischemic and hemorrhagic stroke. There were 31 patients who had infarction lesions in more than 2 vascular systems. The mean age of stroke patients was significantly higher than that of patients without stroke (45.76 ± 17.88 vs. 39.83 ± 15.77, p = 0.000). The incidence of mitral valve vegetation (57.24 vs. 43.01%, p = 0.002), atrial fibrillation (4.34 vs. 1.38%, p = 0.018), fungal infection (2.89 vs. 0.83%, p = 0.038) in patients with stroke was significantly higher than those without stroke. Mitral valve vegetation (OR 1.648; 95% CI 1.113-2.442) and age (OR 1.019; 95% CI 1.007-1.032) were independent risk factors for stroke in IE patients. Stroke increased the risk of hospital deaths (OR 7.673 95%CI 3.634-16.202).

Stroke is a common complication of IE. Mitral valve vegetation and old age may incerease the risk of stroke in patients with IE.