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Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions
Tia Chakraborty1, Eugene Scharf1, Daniel DeSimone2
1Department of Neurology, Mayo Clinic, Rochester, MN.
Mayo Clinic Proceedings
|March 30, 2019
Summary
Brain MRI findings in infective endocarditis (IE) predict outcomes, especially concerning hemorrhage and stroke. Valve surgery improves outcomes despite MRI abnormalities, guiding management for neurological symptoms.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Infective endocarditis (IE) frequently presents with neurological complications.
- Brain magnetic resonance imaging (MRI) is crucial for assessing neurological involvement in IE patients.
Purpose of the Study:
- To evaluate the impact of brain MRI findings on clinical outcomes in IE patients.
- To develop a management strategy for IE patients with neurological symptoms undergoing valve surgery (VS).
Main Methods:
- Retrospective review of 361 IE patients hospitalized between 2007-2014.
- Analysis of MRI findings, postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcomes (modified Rankin Scale).
Main Results:
- 35% of IE patients underwent MRI, revealing abnormalities in 94% of those with neurological symptoms.
- Valve surgery (VS) in patients with MRI abnormalities was associated with lower 6-month mortality and better functional outcomes.
- Lobar ICH and territorial ischemic stroke on MRI predicted mortality and functional outcomes, respectively, irrespective of VS.
Conclusions:
- Brain MRI detects significant abnormalities in IE patients, influencing outcomes.
- Valve surgery improves outcomes in IE patients with neurological symptoms and MRI findings.
- Preoperative lobar hematoma and large territorial stroke are key prognostic indicators in IE.
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