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Clinical and Imaging Characteristics of Infective Endocarditis-Associated Versus Atrial Fibrillation-Associated
Taewoo Kim1, Kwanju Song1, Hyunsun Oh1
1Department of Neurology Asan Medical Center, University of Ulsan, College of Medicine Seoul Korea.
Journal of the American Heart Association
|October 31, 2025
Summary
Infective endocarditis (IE)-stroke presents with smaller, more numerous lesions across multiple brain areas compared to atrial fibrillation stroke. IE-stroke also shows higher recurrence and mortality rates, aiding diagnosis.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a significant cause of cardioembolic stroke with poor outcomes.
- Timely diagnosis of IE-stroke is crucial for effective management.
Purpose of the Study:
- To compare clinical and imaging characteristics of IE-associated stroke (IE-stroke) versus atrial fibrillation (AF) stroke presenting with fever.
- To identify predictors that differentiate IE-stroke from AF stroke.
Main Methods:
- Retrospective review of patients with embolic infarction diagnosed with IE via transthoracic echocardiography.
- Comparison with a control group of AF-stroke patients presenting with fever.
- Analysis of clinical data, neuroimaging findings, lesion patterns, recurrence, and mortality.
Main Results:
- IE-stroke patients (n=170) had smaller lesions, more numerous lesions (>10), and bilateral anterior-posterior circulation involvement compared to AF stroke patients (n=153).
- Independent predictors for IE-stroke included younger age, smaller lesion size, and 3-territory involvement.
- IE-stroke showed higher ischemic lesion recurrence and increased 3-month mortality risk, despite similar parenchymal hematoma rates.
Conclusions:
- IE-stroke lesions are characterized by smaller size, higher number, and wider territorial distribution compared to AF stroke.
- These distinct imaging features, alongside higher recurrence and mortality, can help differentiate IE-stroke in febrile patients with embolic stroke.
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