Adding Fuel to the Fire: Infective Endocarditis and the Challenge of Cerebrovascular Complications

Sharma, Malveeka; Davis, Arielle

doi:10.1007/s11886-023-01856-z

Cited by 2 publications

(1 citation statement)

References 61 publications

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“…In the absence of underlying cardiac conditions such as bicuspid aortic valve, degenerative valvular disease, ventricular septal defect, rheumatic disease, or aortic stenosis the immune system typically generates a robust response to the microbial insult [11]. Although rheumatic heart disease is the most common predisposing condition in developing countries, structural heart conditions and intracardiac devices are the more frequent causes in developed countries [11,37]. Other risk factors include IV drug use, diabetes, poor dentition, chronic liver disease, hemodialysis, immunocompromised state, and neoplastic disease [11].…”

Section: Native Valve Endocarditismentioning

confidence: 99%

Contemporary Features and Management of Endocarditis

Comeaux,

Jamison,

Voeltz

2023

Diagnostics

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Infective endocarditis is a rare but devastating disease. Morbidity and mortality rates have failed to improve despite new technological advances. The disease has evolved over time with new significant populations at risk—most notably those with prosthetic valves or implantable cardiovascular devices. These devices pose new challenges for achieving a timely and accurate diagnosis of infection. While the modified Duke criteria is accepted as the gold standard for diagnosing native valve endocarditis, it has been shown to have significantly inferior sensitivity when it comes to identifying infections related to right-heart endocarditis, prosthetic valves, and indwelling cardiac devices. Additionally, prosthetic valves and cardiovascular implantable electronic devices can exhibit shadowing and artifact, rendering transthoracic echocardiography and transesophageal echocardiography results inconclusive or even normal. Having a keen awareness of the varying clinical presentations, as well as emerging valvular imaging modalities such as F-fluorodeoxyglucose cardiac positron-emission tomography plus computed tomography, promises to improve the evaluation and diagnosis of infective endocarditis. However, indications for appropriate use of these studies and guidance on modern clinical management are still needed.

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Section: Native Valve Endocarditismentioning

confidence: 99%

Contemporary Features and Management of Endocarditis

Comeaux,

Jamison,

Voeltz

2023

Diagnostics

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Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis

Álvarez-Zaballos,

Vázquez-Alen,

Muñoz

et al. 2024

International Journal of Stroke

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Background Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national prospective cohort of IE. Methods Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. Results Out of 5667 IE cases, 1125 had acute stroke (19.8%): 811 ischemic strokes (618 cardioembolic strokes, 193 cardioembolic strokes with hemorrhagic transformation, 4 transient ischemic attacks, 3 lacunar infarctions), 125 intracranial hemorrhages, and 29 other neurological complications (cerebral abscesses, encephalitis, meningitis, seizures). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs. 63.7%, p=0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p=0.01), surgical indication (69.9% vs 65.9%, p=0.001), in-hospital mortality (40.9% vs. 22.0%, p<0.001), and one-year mortality (46.2% vs 27.9%, p<0.001). The following variables were independently associated with stroke: mitral location (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.34-1.8, p<0.001), vascular phenomenon (OR 2.9, 95% CI 2.4-3.6, p=0.0001), acute renal failure (OR 1.2, 95% CI 1.0-1.4, p=0.021), septic shock (OR 1.3, CI 1.1-1.6, p=0.007), sepsis (OR 1.3, CI 1.1-1.6, p=0.005), surgery indicated but not performed (OR 1.4, 95% CI 1.2-1.7, p<0.001), community-acquired IE (OR 1.2, 95% CI 1-1.4, p=0.017), and peripheral embolization (OR 1.6, CI 1.4-1.9, p <0.001). Stroke was an independent predictor of in-hospital (OR 2.1, 95% CI: 1.78-2.51, p<0.001) and one-year mortality (hazard ratio 1.9, 95% CI 1.6-2.5). Conclusions: One fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.

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Adding Fuel to the Fire: Infective Endocarditis and the Challenge of Cerebrovascular Complications

Cited by 2 publications

References 61 publications

Contemporary Features and Management of Endocarditis

Contemporary Features and Management of Endocarditis

Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis

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