Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis
Abstract
Background and Purpose— The aim of this study was to evaluate mortality and neurological outcomes of cardioembolic cerebral stroke in infective endocarditis (IE) patients requiring cardiac surgery. Methods— A consecutive series of 214 patients undergoing cardiac surgery for IE was followed up for 20 years. In 65 patients (mean age, 52 years), IE was complicated by computed tomography– or magnetic resonance imaging–verified stroke (n=61) or transient ischemic attack (n=4). Perioperative (30-day) and long-term mortality was assessed with regression models adjusting for age. Complete neurological recovery of IE survivors was defined by a modified Rankin score of ≤1 and a Barthel index of 20 points. Results— Fifty of 61 stroke patients (81.9%) survived surgery. In comparison with nonstroke patients, the age-adjusted perioperative mortality risk was 1.70-fold (95% CI, 0.73 to 3.96, P =0.22) higher and long-term mortality risk was 1.23-fold (95% CI, 0.72 to 2.11, P =0.45) higher in stroke patients. Patients with complicated stroke (meningitis, hemorrhage, or brain abscess) showed a higher perioperative mortality rate (38.9% vs 8.5%, P =0.007) but no higher neurological complication rate than patients with uncomplicated ischemic stroke. Complete neurological recovery was achieved in 35 IE survivors (70%, 95% CI, 55% to 82%). However, in the case of middle cerebral artery stroke, recovery was only 50% and was significantly lower compared with non—middle cerebral artery stroke ( P =0.012). Conclusion— Uncomplicated IE-related stroke showed a favorable prognosis with regard to both long-term survival and neurological recovery. The formidable risk of secondary cerebral hemorrhage due to cardiac surgery seems to be much lower than previously thought.
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Investigations have suggested better outcomes for infective endocarditis patients with ischemic stroke who undergo early cardiac surgery.
“Investigations have suggested better outcomes for IE patients with ischemic stroke who undergo early cardiac surgery.[268][269][270][271][272]”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [270]
The Discussion reports favorable neurological recovery after cardiac surgery and recommends early surgery for uncomplicated ischemic stroke. But Postoperative Neurological Recovery says surgery within four days versus later was not a relevant factor for neurological complications or recovery, so this study does not establish better outcomes from earlier surgery. (LLM, conf=0.85)
Experimental — accuracy not yet measuredLatency between the neurological event and cardiac surgery was not a significant factor with respect to the perioperative neurological complication rate or the postoperative neurological recovery rate.
“Latency between the neurological event and cardiac surgery was not a significant factor with respect to the perioperative neurological complication rate or the postoperative neurological recovery rate.”
Full neurological recovery was achieved in 70% of 50 stroke patients.
“Full neurological recovery was achieved in 70% of 50 stroke patients.”
Ruttmann et al analyzed 65 patients who underwent cardiac surgery after cardioembolic stroke (median time, 4 days; range, 0-38 days); surgery in this time frame was not associated with worse patient outcomes.
“Ruttmann et al 270 analyzed 65 patients who underwent cardiac surgery after cardioembolic (embolic) stroke (median time, 4 days; range, 0-38 days).Surgery in this time frame was not associated with worse patient outcomes.”
Fifty of 61 patients (81.9%) with CT-verified preoperative stroke survived cardiac surgery.
“Fifty of the 61 patients (81.9%) with CT-verified preoperative stroke survived cardiac surgery.”
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- Authors
- Ruttmann, E., Willeit, J., Ulmer, H., Chevtchik, O., Höfer, D., Poewe, W., Laufer, G., & Müller, L. C.
- Affiliations
- Innsbruck Medical University (AT)
- From the Departments of Cardiac Surgery (E.R., O.C., D.H., G.L., L.C.M.), Neurology (J.W., W.P.), and Medical Statistics, Informatics, and Health Economy (H.U.), Innsbruck Medical University, Innsbruck, Austria.
- Venue
- Stroke
- Published
- 2006-08
- Volume
- 37
- Issue
- 8
- Pages
- 2094-2099
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2123482417
- Semantic Scholar
- 87ed701495629bdb22dea878a365db3d617b1f6d
- Cited by
- 285
- References
- 29
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 15 · 2023: 18 · 2022: 14 · 2021: 15 · 2020: 12 · 2019: 15 · 2018: 14 · 2017: 16 · 2016: 18 · 2015: 20 · 2014: 16 · 2013: 18 · 2012: 13
- FWCI
- 8.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- infective endocarditis, cardioembolic stroke, neurological outcome, long-term mortality, perioperative mortality, neurological recovery, middle cerebral artery stroke, cerebral hemorrhage, brain abscess, meningitis, cardiac surgery, modified Rankin Scale, Barthel Index
- MeSH terms
- Aged, Cerebral Hemorrhage, Brain Ischemia, Endocarditis, Bacterial, Female, Cardiac Surgical Procedures, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Nervous System, Tomography, X-Ray Computed, Incidence, Treatment Outcome, Recovery of Function, Stroke, Intracranial Embolism
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