Cerebral ischemic events in patients with infective endocarditis: results of a single center retrospective study

Autor: D. A. Demin, A. A. Kulesh, S. T. Enginoev, V. V. Demetskaya, E. V. Demina, M. V. Lezhikov, E. I. Shaposhnikova, D. R. Stompel
Jazyk: ruština
Rok vydání: 2023
Předmět:
Zdroj: Неврология, нейропсихиатрия, психосоматика, Vol 15, Iss 4 (2023)
Druh dokumentu: article
ISSN: 2074-2711
2310-1342
DOI: 10.14412/2074-2711-2023-4-31-37
Popis: Cerebral ischemic events, including ischemic stroke (IS) and transient ischemic attack (TIA), are among the most common extracardiac complications of infective endocarditis (IE).Objective: to evaluate cerebral ischemic events (prevalence, clinical and neuroimaging characteristics, predictors, prognosis) in patients with “left-sided” IE, who underwent cardiac surgery, according to the registry of the Federal Center for Cardiovascular Surgery.Material and methods. A retrospective review of data from the hospital information system was performed in one of the federal centers for cardiovascular surgery of the Russian Ministry of Health. Inclusion criteria in the study: age of patients ≥18 years, significant or probable (Duke criteria) IE of the left heart – aortic and/or mitral valves. Patients with isolated right heart IE (tricuspid valve, pacemaker-associated endocarditis), nonbacterial thromboendocarditis, and chronic IE were excluded from the study. For the analysis, 222 cases of IE in 216 patients were used. IS was observed in 43 (19.4%) patients with “left-sided” IE, TIA – in 4 (1.8%). In 2/3 of cases, patients suffered a minor stroke (NIHSS 10 mm (OR 3.552; 95% CI 1.066–11.8463; p=0.039), mobile vegetations (OR 6.112; 95% CI 1.105–33.784; p=0.038) and multiple vegetations (OR 5.2 08, 95% CI 1.189–22.805, p=0.029). The impact of cerebral embolism on prognosis (in-hospital and long-term mortality) in patients undergoing cardiac surgery was not established.Conclusion. According to the neuroimaging data, cerebral infarcts in IE correspond to the main signs of cardioembolism. The characteristics of the vegetations (size >10 mm, mobility, multiplicity) are a crucial indicator of the embolic potential of IE.
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