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Clinical significance of cerebrovascular complications in patients with acute infective endocarditis: a retrospective analysis of a 12-year single-center experience

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Author(s)
Seung-Jae LeeSam-Sae OhDal-Soo LimChan-Young NaJae-Hyun Kim
Keimyung Author(s)
Kim, Jae HyunNa, Chan Young
Department
Dept. of Thoracic & Cardiovascular Surgery (흉부외과학)
Journal Title
BMC Neurology
Issued Date
2014
Volume
14
Issue
1
Abstract
BACKGROUND:
Cerebrovascular complications (CVCs) frequently occur in patients with acute infective endocarditis (IE). The aim of this study is to describe the clinical findings of CVCs and to evaluate the impact of CVCs on long-term mortality in patients with IE.

METHODS:
We retrospectively analyzed 144 patients who fulfilled the modified Duke's criteria for definite left-sided IE. CVCs were classified into minor (silent cerebral embolism, TIA and stroke with an initial modified Rankin scale ≤ 2) or major (an initial modified Rankin scale ≥ 3) CVCs. Cox proportional hazards model was used for mortality analysis. Hazard ratio (HR) and 95% confidence interval (CI) were obtained.

RESULTS:
The mean age of the 144 patients (96 males and 48 females) was 49.1 years (range 6-85 years). A CVC was found in 37 (25.7%) patients. Of these, 25 were treated with surgical therapy. The patients who underwent early surgery within 2 weeks after stroke had a statistical trend toward a higher risk of postoperative brain hemorrhage (50% versus 4.8%, P = 0.057 by Fisher exact test). The minor CVC group had a similar risk of death as the no-CVC group (P = 0.803; HR 0.856; CI 0.253-2.894), whereas the major CVC group had a higher mortality (P = 0.013; HR 2.865; CI 1.254-6.548) than the no-CVC group. In the multivariate analysis, major CVC (P = 0.002; HR 3.893; CI 1.649-9.194) was a significant predictor of mortality in IE patients, together with advanced age (P = 0.005; HR 3.138; CI 1.421-6.930) and prosthetic valve IE (P = 0.008; HR 2.819; CI 1.315-6.044).

CONCLUSIONS:
IE can give rise to various forms of CVC, most frequently, acute ischemic brain lesions. In our study, major CVC was associated with high risk of mortality although total CVC was not significantly related to the risk of death in patients with IE.
Keimyung Author(s)(Kor)
김재현
나찬영
Publisher
School of Medicine
Citation
Seung-Jae Lee et al. (2014). Clinical significance of cerebrovascular complications in patients with acute infective endocarditis: a retrospective analysis of a 12-year single-center experience. BMC Neurology, 14(1), 30–30. doi: 10.1186/1471-2377-14-30
Type
Article
ISSN
1471-2377
DOI
10.1186/1471-2377-14-30
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/35245
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Thoracic & Cardiovascular Surgery (흉부외과학)
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