Cited by 223Infective Endocarditis Diagnosis and ManagementInfectious Diseases and TuberculosisAcute Ischemic Stroke Management

Subclinical Brain Embolization in Left-Sided Infective Endocarditis: Results From the Evaluation by MRI of the Brains of Patients With Left-Sided Intracardiac Solid Masses (EMBOLISM) Pilot Study

Cooper, Howard A., Thompson, Elissa C., Laureno, Robert, Fuisz, Anthon, Mark, Alexander S., Lin, Mark, Goldstein, Steven A.·2009·Circulation

Abstract

Background— Acute brain embolization (ABE) in left-sided infective endocarditis has significant implications for clinical decision making. The true incidence of ABE, including subclinical brain embolization, is unknown. Methods and Results— We prospectively studied 56 patients with definite left-sided infective endocarditis. Patients were examined by a study neurologist, and those without contraindication had magnetic resonance imaging of the brain. Patients without clinical evidence of acute stroke but with magnetic resonance imaging evidence of ABE were considered to have subclinical brain embolization. Clinical stroke was present in 14 of 56 patients (25%). Among 40 patients undergoing magnetic resonance imaging, the incidence rates of subclinical brain embolization and any ABE were 48% and 80%, respectively. ABE was present in 18 of 19 patients (95%) with Staphylococcus aureus infection. At 3 months, mortality was similar among patients with clinical stroke and subclinical brain embolization (62% versus 53%; P =NS) and was higher among patients with any ABE than among those without ABE (56% versus 12%; P =0.046). Valvular surgery was performed in 25 patients (45%), including 16 with ABE, at a median of 4 days. No patient suffered a postoperative neurological complication. Surgery was independently associated with a lower risk of mortality at 3 months (odds ratio, 0.1; 95% confidence interval, 0.03 to 0.6; P =0.008). Conclusions— Magnetic resonance imaging detected subclinical brain embolization in a substantial number of patients with left-sided infective endocarditis, suggesting that the incidence of ABE may be significantly higher than reports based on clinical and computed tomography findings have indicated. Brain magnetic resonance imaging may play a role in the complex decision about surgical intervention in infective endocarditis.

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Crossref · 10.1161/circulationaha.108.834432

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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 [268]

    Clinical Outcomes (p. 4) reports lower mortality among surgical patients in the overall left-sided infective endocarditis cohort, and the Discussion (p. 6) says early surgery was associated with reduced mortality. For patients with clinical stroke or subclinical brain embolization, the paper reports no postoperative neurological events after early surgery, but it does not establish better survival specifically for patients with ischemic stroke who undergo early surgery. (LLM, conf=0.86)

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Authors
Cooper, H. A., Thompson, E. C., Laureno, R., Fuisz, A., Mark, A. S., Lin, M., & Goldstein, S. A.
Affiliations
MedStar Washington Hospital Center (US)
Venue
Circulation
Published
2009-08-18
Volume
120
Issue
7
Pages
585-591
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W1977906308
Cited by
223
References
32
Citations by year
2026: 8 · 2025: 16 · 2024: 27 · 2023: 11 · 2022: 10 · 2021: 12 · 2020: 6 · 2019: 19 · 2018: 7 · 2017: 18 · 2016: 15 · 2015: 16 · 2014: 12 · 2013: 18 · 2012: 8
FWCI
6.27
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
left-sided endocarditis, Staphylococcus aureus endocarditis, stroke, brain MRI, heart valve surgery, mortality, timing of surgery
MeSH terms
Adult, Aged, Aged, 80 and over, Brain, Echocardiography, Endocarditis, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pilot Projects, Prospective Studies, Staphylococcal Infections, Staphylococcus aureus, Incidence, Stroke, Intracranial Embolism

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