Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study
Abstract
AIMS: To analyse the risk of death according to the type of cerebrovascular complications (CVC) during infective endocarditis (IE) and to analyse the determinants of outcome in patients with IE and a CVC. METHODS AND RESULTS: In two referral centres, 496 consecutive patients with definite IE were prospectively included. Cerebral CT scan was performed in 453 patients. During a mean 2.9 year follow-up, 139 (28%) patients died and CVC occurred in 109 (22%) patients. Stroke was an independent predictor of death, although no significant excess mortality was observed in patients with silent CVC or transient ischaemic attack (TIA). Among CVC patients, mortality was predicted by the presence of a mechanical prosthetic valve IE and a low Glasgow Coma Scale. When valvular surgery was performed in patients after CVC, neurologic exacerbation was rare [4 (6.3%) patients] and was observed only in patients with symptomatic stroke. Among CVC patients, survival was better in operated patients when compared with patients treated conservatively despite theoretical indication for surgery (P < 0.0001). However, the latter group had more comorbidities (P = 0.007) and a lower Glasgow Coma Scale (14.6 +/- 1 vs. 12 +/- 4, P < 0.0001). CONCLUSION: Patients with silent CVC or TIA have a relatively good prognosis, whereas those with stroke have significant excess mortality particularly in case of mechanical prosthetic valve IE or impaired consciousness. Valvular surgery can be safely performed after silent CVC or TIA and may improve survival in selected patients with stroke.
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Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742 · see citing works
ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS
Teasdale, G., & Jennett, B. (1974) · The Lancet · doi:10.1016/s0140-6736(74)91639-0 · Cited by 13,215 · see citing works
Modeling Survival Data: Extending the Cox Model
Therneau, T. M., & Grambsch, P. M. (2000) · Statistics for Biology and Health · doi:10.1007/978-1-4757-3294-8 · Cited by 8,674 · see citing works
The natural history of congestive heart failure: the Framingham study
McKee, P. A., Castelli, W. P., McNamara, P. M., & Kannel, W. B. (1971) · New England Journal of Medicine · doi:10.1056/nejm197112232852601 · Cited by 3,448 · see citing works
Durack, D. T., Lukes, A. S., Bright, D. K., & Service, D. E. (1994) · The American Journal of Medicine · doi:10.1016/0002-9343(94)90143-0 · Cited by 2,572 · see citing works
Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler, V. G., Bolger, A. F., Levison, M. E., Ferrieri, P., Gerber, M. A., Tani, L. Y., Gewitz, M. H., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.165564 · Cited by 1,707 · see citing works
Infective Endocarditis in Adults
Mylonakis, E. E., & Calderwood, S. B. (2001) · New England Journal of Medicine · doi:10.1056/nejmra010082 · Cited by 1,335 · see citing works
Color Doppler assessment of mitral regurgitation with orthogonal planes.
Helmcke, F. R., Nanda, N. C., Hsiung, M. C., Soto, B., Adey, C. K., Goyal, R. G., & Gatewood, R. P. (1987) · Circulation · doi:10.1161/01.cir.75.1.175 · Cited by 1,219 · see citing works
Evaluation of aortic insufficiency by Doppler color flow mapping
Perry, G. J., Helmcke, F., Nanda, N. C., Byard, C., & Soto, B. (1987) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(87)80254-1 · Cited by 881 · see citing works
Guidelines for the Management of Spontaneous Intracerebral Hemorrhage
Broderick, J. P., Adams, H. P., Barsan, W. G., Feinberg, W. M., Feldmann, E. G., Grotta, J. C., Kase, C. S., Krieger, D., Mayberg, M. R., Tilley, B. C., et al. (1999) · Stroke · doi:10.1161/01.str.30.4.905 · Cited by 829 · see citing works
Daniel, W. G., Mügge, A., Martin, R. P., Lindert, O., Hausmann, D., Nonnast-Daniel, B., Laas, J., & Lichtlen, P. R. (1991) · New England Journal of Medicine · doi:10.1056/nejm199103213241203 · Cited by 723 · see citing works
Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis Executive Summary
Horstkotte, D., Follath, F., Gutschik, E., Lengyel, M., Oto, A., Pavie, A., Soler‐Soler, J., Thiene, G., von Graevenitz, A., Priori, S. G., et al. (2004) · European Heart Journal · doi:10.1016/j.ehj.2003.11.008 · Cited by 715 · see citing works
Thuny, F., Disalvo, G., Belliard, O., Avierinos, J.-F., Pergola, V., Rosenberg, V., Casalta, J.-P., Gouvernet, J., Derumeaux, G., Iarussi, D., et al. (2005) · Circulation · doi:10.1161/circulationaha.104.493155 · Cited by 703 · see citing works
Self-citationStroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989.
Brown, R. D., Whisnant, J. P., Sicks, J. D., O’Fallon, W. M., & Wiebers, D. O. (1996) · PubMed · Cited by 639 · see citing works
Mayberg, M. R., Batjer, H. H., Dacey, R. G., Diringer, M. N., Haley, E. C., Heros, R. C., Sternau, L., Torner, J. C., Adams, H. P., & Feinberg, W. M. (1994) · Circulation · doi:10.1161/01.cir.90.5.2592 · Cited by 509 · see citing works
Echocardiography predicts embolic events in infective endocarditis
Di Salvo, G., Habib, G., Pergola, V., Avierinos, J.-F., Philip, E., Casalta, J.-P., Vailloud, J.-M., Derumeaux, G., Gouvernet, J., Ambrosi, P., et al. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)01206-7 · Cited by 457 · see citing works
Self-citationHeiro, M., Nikoskelainen, J., Engblom, E., Kotilainen, E., Marttila, R., & Kotilainen, P. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.18.2781 · Cited by 415 · see citing works
Complicated Left-Sided Native Valve Endocarditis in Adults
Hasbun, R., Vikram, H. R., Barakat, L., Buenconsejo, J., & Quagliarello, V. (2003) · JAMA · doi:10.1001/jama.289.15.1933 · Cited by 333 · see citing works
Surgical management of infective endocarditis associated with cerebral complications
Eishi, K., Kawazoe, K., Kuriyama, Y., Kitoh, Y., Kawashima, Y., & Omae, T. (1995) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(95)70038-2 · Cited by 299 · see citing works
Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis
Ruttmann, E., Willeit, J., Ulmer, H., Chevtchik, O., Höfer, D., Poewe, W., Laufer, G., & Müller, L. C. (2006) · Stroke · doi:10.1161/01.str.0000229894.28591.3f · Cited by 285 · see citing works
Stroke in infective endocarditis.
Hart, R., Foster, J. W., Luther, M. F., & Kanter, M. C. (1990) · Stroke · doi:10.1161/01.str.21.5.695 · Cited by 253 · see citing works
The risk of stroke and death in patients with aortic and mitral valve endocarditis
Cabell, C. H., Pond, K. K., Peterson, G., Durack, D. T., Corey, G. R., Anderson, D. J., Ryan, T., Lukes, A. S., & Sexton, D. J. (2001) · American Heart Journal · doi:10.1067/mhj.2001.115790 · Cited by 216 · see citing works
Infective Endocarditis Due to Staphylococcus aureus: Deleterious Effect of Anticoagulant Therapy
Tornos, P., Almirante, B., Mirabet, S., Permanyer, G., Pahissa, A., & Soler-Soler, J. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.5.473 · Cited by 214 · see citing works
Neurologic Manifestations of Bacterial Endocarditis
Jones, H. R., SIEKERT, R. G., & GERACI, J. E. (1969) · Annals of Internal Medicine · doi:10.7326/0003-4819-71-1-21 · Cited by 190 · see citing works
Røoder, B. L., WANDALL, D. A., Espersen, F., Frimodt-Møoller, N., Skinhøj, P., & Rosdahl, V. T. (1997) · The American Journal of Medicine · doi:10.1016/s0002-9343(97)00090-9 · Cited by 155 · see citing works
Stroke is not a contraindication for urgent valve replacement in acute infective endocarditis.
Piper, C., Wiemer, M., Schulte, H. D., & Horstkotte, D. (2001) · PubMed · Cited by 142 · see citing works
Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis
Anderson, D. J., Goldstein, L. B., Wilkinson, W. E., Corey, G. R., Cabell, C. H., Sanders, L. L., & Sexton, D. J. (2003) · Neurology · doi:10.1212/01.wnl.0000094359.47929.e4 · Cited by 134 · see citing works
Guidelines on prevention, diagnosis and treatment of infective endocarditis: executive summary
Horstkotte, D., Folláth, F., & Gutschik, E. (2004) · ACC Current Journal Review · doi:10.1016/j.accreview.2004.04.021 · Cited by 134 · see citing works
Incidence of Transient Ischemic Attack in Rochester, Minnesota, 1985–1989
Brown, R. D., Petty, G. W., O’Fallon, W. M., et al. (1998) · Stroke · doi:10.1161/01.str.29.10.2109 · Cited by 114 · see citing works
Cerebrovascular accidents in infective endocarditis: role of anticoagulation
DELAHAYE, J. P., PONCET, P., Malquarti, V., Beaune, J., Garé, J. P., & Mann, J. M. (1990) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a059645 · Cited by 85 · see citing works
INFECTIVE ENDOCARDITIS IN ADULTS
&NA; (2002) · Infectious Diseases in Clinical Practice · doi:10.1097/00019048-200201000-00021 · Cited by 78 · see citing works
Thuny, F., DiSalvo, G., & Belliard, O. (2005) · ACC Current Journal Review · doi:10.1016/j.accreview.2005.10.036 · Cited by 75 · see citing works
Self-citationHemorrhage After an Acute Ischemic Stroke
Motto, C., Ciccone, A., Aritzu, E., et al. (1999) · Stroke · doi:10.1161/01.str.30.4.761 · Cited by 69 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [6]6. Hart RG, Foster JW, Luther MF, Kanter MC. Stroke in infective endocardi- tis. Stroke 1990;21:695-700.
- [18]18. Motto C, Ciccone A, Aritzu E, Boccardi E, De Grandi C, Piana A, Candelise L. Haemorrhage after an acute ischaemic stroke. MAST-I Colla- borative Group. Stroke 1999;30:761-764.
Cited by
Sorted by citations
Otto, C. M., Nishimura, R. A., Bonow, R. O., Carabello, B. A., Erwin, J. P., Gentile, F., Jneid, H., Krieger, E. V., Mack, M., McLeod, C., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000923 · Cited by 3,686 · see citing works
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease
Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A., O’Gara, P. T., Ruiz, C. E., Skubas, N. J., Sorajja, P., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.02.536 · Cited by 3,523 · see citing works
Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler, V. G., Tleyjeh, I. M., Rybak, M. J., Barsic, B., Lockhart, P. B., Gewitz, M. H., Levison, M. E., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000296 · Cited by 3,232 · see citing works
Otto, C. M., Nishimura, R. A., Bonow, R. O., Carabello, B. A., Erwin, J. P., Gentile, F., Jneid, H., Krieger, E. V., Mack, M., McLeod, C., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000932 · Cited by 2,449 · see citing works
Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009)
Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and by the International Society of Chemotherapy (ISC) for Infection and Cancer, Habib, G., Hoen, B., Tornos, P., Thuny, F., Prendergast, B., Vilacosta, I., Moreillon, P., de Jesus Antunes, M., Thilen, U., et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp285 · Cited by 2,014 · see citing works
Self-citationGarcía-Cabrera, E., Fernández-Hidalgo, N., Almirante, B., Ivanova-Georgieva, R., Noureddine, M., Plata, A., Lomas, J. M., Gálvez-Acebal, J., Hidalgo-Tenorio, C., Ruíz-Morales, J., et al. (2013) · Circulation · doi:10.1161/circulationaha.112.000813 · Cited by 546 · see citing works
Snygg‐Martin, U., Gustafsson, L., Rosengren, L., Alsiö, Å., Ackerholm, P., Andersson, R., & Olaison, L. (2008) · Clinical Infectious Diseases · doi:10.1086/588663 · Cited by 320 · see citing works
Duval, X., Iung, B., Klein, I., Brochet, E., Thabut, G., Arnoult, F., Lepage, L., Laissy, J.-P., Wolff, M., Leport, C., et al. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-152-8-201004200-00006 · Cited by 289 · see citing works
2020 ACC/AHA guideline for the management of patients with valvular heart disease
Otto, C. M., Nishimura, R. A., Bonow, R. O., Carabello, B. A., Erwin, J. P., Gentile, F., Jneid, H., Krieger, E. V., Mack, M., McLeod, C., et al. (2021) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2021.04.002 · Cited by 279 · see citing works
Cooper, H. A., Thompson, E. C., Laureno, R., Fuisz, A., Mark, A. S., Lin, M., & Goldstein, S. A. (2009) · Circulation · doi:10.1161/circulationaha.108.834432 · Cited by 223 · see citing works
Barsic, B., Dickerman, S., Krajinovic, V., Pappas, P., Altclas, J., Carosi, G., Casabé, J. H., Chu, V. H., Delahaye, F., Edathodu, J., et al. (2013) · Clinical Infectious Diseases · doi:10.1093/cid/cis878 · Cited by 157 · see citing works
- Authors
- Thuny, F., Avierinos, J.-F., Tribouilloy, C., Giorgi, R., Casalta, J.-P., Milandre, L., Brahim, A., Nadji, G., Riberi, A., Collart, F., Renard, S., Raoult, D., & Habib, G.
- Affiliations
- Hôpital de la Timone (FR)
- Centre Hospitalier Universitaire Amiens-Picardie (FR)
- Corresponding author
- Habib, G.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-05-01
- Volume
- 28
- Issue
- 9
- Pages
- 1155-1161
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2156742574
- Semantic Scholar
- 91dd18492019c266a5e791dcd7ae8d5ebcefeb6a
- Cited by
- 396
- References
- 33
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 21 · 2023: 24 · 2022: 22 · 2021: 26 · 2020: 23 · 2019: 30 · 2018: 20 · 2017: 14 · 2016: 21 · 2015: 29 · 2014: 32 · 2013: 19 · 2012: 17
- FWCI
- 10.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- infective endocarditis, cerebrovascular complications, stroke, transient ischemic attack, silent cerebral infarction, mortality, neurological outcome, mechanical prosthetic valves, heart valve surgery, Glasgow Coma Scale, head CT
- MeSH terms
- Cerebrovascular Disorders, Endocarditis, Bacterial, Female, France, Heart Valve Diseases, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Multivariate Analysis, Survival Analysis
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