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Risk factors for neurological complications in left-sided infective endocarditis

Alvin S Das1, Morgan McKeown2, Stephanie A Jordan2

  • 1Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, United States of America.

Journal of the Neurological Sciences
|August 28, 2022
PubMed

Insights

Large vegetation size increases stroke risk in infective endocarditis (IE). Mycotic aneurysms cause intraparenchymal hemorrhage, while prosthetic valves and Staphylococcus aureus infection are linked to cerebral microbleeds (CMB).

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiology

Background:

  • Neurological complications significantly increase long-term morbidity in infective endocarditis (IE) patients.
  • Understanding risk factors for these complications is crucial for patient management.

Purpose of the Study:

  • To identify risk factors for various neurological complications in left-sided infective endocarditis.
  • To analyze the frequency of cerebral infarcts, intraparenchymal hemorrhage, cerebral microbleeds (CMB), mycotic aneurysms, and encephalopathy in IE patients.

Main Methods:

  • Retrospective analysis of 211 adult patients with left-sided IE from 2015-2019.
  • Determined frequency of neurological complications and used multivariable regression to identify predictors.
  • Variables with p < 0.1 were analyzed alongside age.

Main Results:

  • Infarcts occurred in 56% of patients; large vegetation size (≥15 mm) predicted infarcts (aOR 2.26).
  • Mycotic aneurysms (10%) were a strong risk factor for intraparenchymal hemorrhage (aOR 18.79).
  • Prosthetic valves and Staphylococcus aureus infection were associated with CMB (27%).

Conclusions:

  • Large vegetation size is a key predictor of stroke in infective endocarditis.
  • Mycotic aneurysms are a primary cause of intraparenchymal hemorrhage.
  • Cerebral microbleeds may be linked to prosthetic valves and Staphylococcus aureus infections.
Abstract

Keywords:
Cerebrovascular diseasesInfective endocarditisNeuroimagingStroke

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