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Role of Cerebral Imaging on Diagnosis and Management in Patients With Suspected Infective Endocarditis

Matthaios Papadimitriou-Olivgeris1, Benoit Guery1, Nicoleta Ianculescu2

  • 1Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 31, 2023
PubMed

Insights

Cerebral imaging in infective endocarditis (IE) patients with neurological symptoms aids diagnosis. For asymptomatic IE patients, cerebral imaging influences surgical decisions, potentially leading to new operative indications for valvular surgery.

Area of Science:

  • Neurology
  • Cardiology
  • Infectious Diseases

Background:

  • Cerebral embolic events (CEEs) are frequent complications of infective endocarditis (IE).
  • CEEs significantly impact the diagnosis and treatment strategies for IE patients.
  • Assessing the utility of cerebral imaging (Cer-Im) in suspected IE cases is crucial.

Purpose of the Study:

  • To evaluate the role of cerebral imaging (Cer-Im) in diagnosing and managing patients with suspected infective endocarditis (IE).
  • To determine if Cer-Im influences diagnostic classification and therapeutic planning in IE patients.

Main Methods:

  • Retrospective study of 573 patients with suspected IE and available Cer-Im data.
  • Patients were categorized based on modified Duke criteria (ESC guidelines).
  • Analysis of neurological symptoms, CEE presence, and impact of Cer-Im on IE diagnosis and surgical indications.

Main Results:

  • 42% of patients with suspected IE had neurological symptoms; 44% had at least one CEE.
  • Cer-Im findings led to reclassification of IE diagnosis in 5% of patients.
  • In patients with possible or definite IE, 57% had CEEs; 22% of IE patients and 19% of asymptomatic IE patients received new surgical indications based on Cer-Im.

Conclusions:

  • Cerebral imaging has limited impact on diagnosing IE in asymptomatic patients.
  • However, Cer-Im in asymptomatic IE patients is valuable for surgical decision-making, establishing new operative indications in approximately one-fifth of cases.
  • Cer-Im plays a significant role in managing IE patients, particularly in guiding surgical interventions.
Abstract

Keywords:
MRIembolizationinfective endocarditisischemic lesionsvalve surgery

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