Stroke in patients with prosthetic valve endocarditis : Single-center cohort study in China

This study summarizes the clinical features of stroke in patients with prosthetic valve endocarditis (PVE) in China.

The clinical data of PVE patients admitted to Beijing Anzhen Hospital from January 1997 to August 2018 were retrospectively analyzed.

In total, 62 patients with PVE were enrolled (45 males, 17 females). The patients' age ranged from 23 to 79 years (51.69 ± 15.01). Rheumatic heart disease (RHD) was the most common reason for valve replacement. Of the patients, 58 were found to have vegetations by echocardiography. Blood cultures revealed the most common pathogens to be Staphylococcus (12 cases) and fungal infections (n = 7); 18 (29.03%) patients had strokes. There were 12 cases of ischemic stroke, three cases of cerebral hemorrhage, one case of subarachnoid hemorrhage, and two cases of unclear etiology. The most commonly found clinical symptoms of stroke patients were hemiplegia (n = 10) and coma (n = 5). The five patients in coma died during hospitalization. The incidence of RHD, double valve replacement, atrial fibrillation, and mitral valve vegetation was significantly higher in the stroke group than in the non-stroke group (p = 0.045, 0.000, 0.033, and 0.045, respectively). Logistic regression analysis showed that the odds ratios (ORs) for RHD, double valve replacement, and fungal infection as risk factors of stroke were 7.26 (95% CI: 1.23-42.68), 25.60 (95%CI: 4.33-126.16), and 20.58 (95% CI: 2.13-198.82), respectively, and were statistically significant. Eight patients died during hospitalization and the in-hospital mortality was 12.90%. The OR for in-hospital mortality with concurrent stroke was 5.13 (95% CI: 1.08-24.46, p = 0.028).

Stroke is a common complication in PVE that increases patient mortality. Rheumatic heart disease, double valve replacement, and fungal infection may be risk factors for patients with PVE complicated by stroke.