Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Neurological complications in infective endocarditis: insights from a tertiary centre
Session:
CO 17 - Doença Valvular
Speaker:
Sofia Alegria
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sofia Alegria; Dra. Inês Cruz; Ana I. Marques; Ana Broa ; Ana Catarina Gomes; Ana Rita F. Pereira; Daniel Sebaiti; Isabel João; Otilia Ferreira Simões ; Helder Pereira
Abstract
<p><strong>Background:</strong> Neurological complications are frequent in infective endocarditis (IE) and a wide spectrum of neurological disorders may be observed. Recent data suggests that neurologic events are a major determinant of prognosis, and that surgery has a central role in improving the outcome.</p> <p><strong>Aim: </strong>To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and of mortality.</p> <p><strong>Methods: </strong>Retrospective analysis of patients admitted in a tertiary center with the diagnosis of IE from 2006 to 2016. </p> <p><strong>Results: </strong>We identified 148 episodes of IE (142 pts), 34.5% with evidence of systemic embolization. The most frequent site was the CNS (n=29; 19.6%). Patients with CNS embolization were predominantly male, with a mean age of 61±12 years; 10.3% were IV drug users, and 6.9% had HIV infection; none had involvement of right-sided valves; the most common agents were Streptococcus (31.0%) and Staphylococcus (27.6%). Patients presented with ischemic stroke in 75.9% of cases (haemorrhagic transformation in 27.3%), haemorrhagic stroke in 17.2%, mycotic aneurysm in 17.2%, and myelitis / meningitis in 3.4%. 34.5% had recurrence of stroke (including both ischemic and haemorrhagic). During follow-up (mean 805±1248 days), 32.1% were submitted to surgery (median time from admission to surgery 35 days); both in-hospital mortality and 1-year mortality were 39.3%.</p> <p>Comparing with the global population, patients with CNS embolization were more likely to be younger, to have diabetes, no fever at presentation and no involvement of right-sides valves (p<0.05 in all cases). In addition, they had longer hospitalizations (51 <em>vs</em> 38 days; p=0.027), although there were no differences regarding mortality or the proportion of patients submitted to surgery. In multivariate logistic regression, the independent predictors of CNS embolization were age ≤ 75 years (HR 6.0; 95% CI 1.2-29.1; p=0.025), diabetes (HR 4.7; 95% CI 1.7-12.9; p=0.002) and the absence of fever at presentation (HR 2.5; 95% CI 1.0-6.1; p=0.049).</p> <p>Among patients with CNS embolization, surgery was associated with reduced mortality, both in-hospital and at 1 year (1-year mortality: 0 <em>vs</em> 57.9%, p=0.005; Kaplan-Meier survival analysis, log rank p=0.006). In multivariate Cox regression, HIV infection was the only independent predictor of 1-year mortality (HR 10.6; 95% CI 1.7-64.8; p=0.011).</p> <p><strong>Conclusions:</strong> In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without differences in mortality. This study is in line with recent data that showed that, in patients with CNS embolization, surgery should be the favoured approach. It also shows that patients with HIV infection have a particularly poor prognosis, highlighting the role of the endocarditis team with a multidisciplinary approach.</p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site