Strokes in Patients With Injection Drug Use and Tricuspid Valve Endocarditis - A Case Series

Area of Science:

• Infectious Diseases
• Cardiology
• Neurology

Background:

• Tricuspid valve infective endocarditis (TVIE) is a serious condition often linked to injection drug use (IDU).
• Ischemic stroke is a potential complication of TVIE, particularly in patients with a history of IDU.

Purpose of the Study:

• To describe the clinical characteristics and outcomes of patients with TVIE and concomitant ischemic stroke.
• To investigate the association between IDU and stroke in TVIE patients.
• To highlight the need for improved neuroimaging protocols in this population.

Main Methods:

• Retrospective analysis of patients from a tertiary care safety-net hospital endocarditis registry.
• Inclusion criteria: bacteremia, tricuspid valve vegetations, and neuroimaging consistent with ischemic stroke.
• Data collected included neurologic exams, IDU history, blood cultures, echocardiography, neuroimaging, and Modified Rankin Scale (mRS) scores.

Main Results:

• Of 188 patients, 66 had TVIE, and 10 of these experienced ischemic stroke.
• Nine stroke cases were associated with IDU, with S. aureus identified in blood cultures for eight.
• Neurologic presentations were non-specific; altered mental status was common, and focal deficits were rare. Three patients died.
• Survivor mRS scores ranged from 0-4.

Conclusions:

• Strokes associated with TVIE present heterogeneously with unclear mechanisms.
• There is a noted lack of robust neuroimaging for TVIE patients with IDU, suggesting potential benefits for stroke screening and peri-operative management.
• Further research is required to fully understand stroke mechanisms in this patient group.