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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.
Insights
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.
Background:
Infective endocarditis (IE) is a major cause of cardioembolic stroke, leading to poor outcomes if not diagnosed appropriately. We compared clinical and imaging characteristics between IE-associated stroke (IE-stroke) and atrial fibrillation stroke presenting with fever.
Methods:
Patients with embolic infarction diagnosed with IE based on transthoracic echocardiography were reviewed. Patients with atrial fibrillation-stroke presenting with fever served as the comparator group. Clinical characteristics, imaging characteristics, and outcomes were compared. Lesion patterns were analyzed according to the number of lesions and vascular territories. Parenchymal hematoma, stroke recurrence, and mortality were also investigated.
Results:
The study included 170 patients with IE-stroke and 153 patients with atrial fibrillation stroke. Those with IE-stroke demonstrated smaller lesions (21.6±19.3 mm versus 66.9±38.0 mm, P<0.001), a higher proportion with >10 lesions (44.7% versus 5.2%, P<0.001), and predominant bilateral anterior-posterior circulation involvement (54.1% versus 2.6%, P<0.001). Independent predictors of IE-stroke included younger age (odds ratio [OR], 0.87 [95% CI, 0.82-0.92], P<0.001), smaller lesion size (OR, 0.94 95% CI, 0.92-0.97, P<0.001), and 3-territory involvement (OR, 81.21 [95% CI, 16.20-407.00], P<0.001). Parenchymal hematoma rates were comparable (12.9% versus 11.1%, P=0.614). Ischemic lesion recurrence was higher in IE-stroke (53.2% versus 18.1%; OR, 6.94 [95% CI, 3.41-14.12], P<0.001). Although unadjusted mortality rates did not differ, adjusted analysis showed higher odds of 3-month mortality in IE-stroke (OR, 3.82 [95% CI, 1.71-8.50], P=0.001).
Conclusions:
IE-stroke lesions were more numerous, smaller, and dispersed across multiple vascular territories with higher recurrence rates compared with atrial fibrillation stroke. Despite lesion size difference, parenchymal hematoma rates were similar. These characteristics may aid in distinguishing IE-stroke in patients with embolic stroke and fever.
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