Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis

Tia Chakraborty, Eugene Scharf, Alejandro Rabinstein, Daniel DeSimone, Abdelghani El Rafei, Waleed Brinjikji, Larry M. Baddour, Eelco Wijdicks, Walter Wilson, James M. Steckelberg, Jennifer E. Fugate

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Brain magnetic resonance imaging (MRI) is frequently obtained in patients with infective endocarditis, yet its utility in predicting outcomes for valve replacement surgery in patients is unknown. The objective of this study was to determine how brain MRI findings impact clinical management and outcomes. Methods Demographic and clinical data from electronic medical records at Mayo Clinic were retrospectively reviewed for patients hospitalized with definite or possible infective endocarditis according to the modified Duke criteria between January 1, 2007 and December 31, 2014. There were 364 patients included in the study. Results Cardiac valve replacement surgery was performed in 195 of 364 (53.6%) patients, and 95 (48.7%) of the surgical patients underwent preoperative MRI, which was associated with preoperative neurologic symptoms in 56 of 95 (58.9%) patients (odds ratio = 12.92; 95% confidence interval, 5.98-27.93; P <.001). Postoperative neurologic complications occurred in 24 of 195 (12.3%) patients, including new ischemic stroke in 4 of 195 (2.1%) and new intracerebral hemorrhage in 3 of 195 (1.5%). No patients with microhemorrhages developed postoperative hemorrhage. No significant differences existed in rates of postoperative complications between patients with and those without preoperative MRI. There were no substantial associations between preoperative MRI findings and postoperative neurologic complications, functional outcomes as described by the modified Rankin Scale score, or 6-month mortality. Conclusions In patients undergoing valve replacement surgery, preoperative MRI findings were not associated with differences in postoperative outcomes, irrespective of finding or timing of valve replacement surgery.

Original languageEnglish (US)
Pages (from-to)2527-2535
Number of pages9
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Endocarditis
Magnetic Resonance Imaging
Brain
Neurologic Manifestations
Postoperative Hemorrhage
Electronic Health Records
Heart Valves
Cerebral Hemorrhage
Nervous System
Stroke
Odds Ratio
Demography
Confidence Intervals
Mortality

Keywords

  • Endocarditis
  • hemorrhage
  • MRI
  • stroke
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis. / Chakraborty, Tia; Scharf, Eugene; Rabinstein, Alejandro; DeSimone, Daniel; El Rafei, Abdelghani; Brinjikji, Waleed; Baddour, Larry M.; Wijdicks, Eelco; Wilson, Walter; Steckelberg, James M.; Fugate, Jennifer E.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 26, No. 11, 01.11.2017, p. 2527-2535.

Research output: Contribution to journalArticle

Chakraborty, T, Scharf, E, Rabinstein, A, DeSimone, D, El Rafei, A, Brinjikji, W, Baddour, LM, Wijdicks, E, Wilson, W, Steckelberg, JM & Fugate, JE 2017, 'Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis', Journal of Stroke and Cerebrovascular Diseases, vol. 26, no. 11, pp. 2527-2535. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.05.047
Chakraborty, Tia ; Scharf, Eugene ; Rabinstein, Alejandro ; DeSimone, Daniel ; El Rafei, Abdelghani ; Brinjikji, Waleed ; Baddour, Larry M. ; Wijdicks, Eelco ; Wilson, Walter ; Steckelberg, James M. ; Fugate, Jennifer E. / Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis. In: Journal of Stroke and Cerebrovascular Diseases. 2017 ; Vol. 26, No. 11. pp. 2527-2535.
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abstract = "Background Brain magnetic resonance imaging (MRI) is frequently obtained in patients with infective endocarditis, yet its utility in predicting outcomes for valve replacement surgery in patients is unknown. The objective of this study was to determine how brain MRI findings impact clinical management and outcomes. Methods Demographic and clinical data from electronic medical records at Mayo Clinic were retrospectively reviewed for patients hospitalized with definite or possible infective endocarditis according to the modified Duke criteria between January 1, 2007 and December 31, 2014. There were 364 patients included in the study. Results Cardiac valve replacement surgery was performed in 195 of 364 (53.6{\%}) patients, and 95 (48.7{\%}) of the surgical patients underwent preoperative MRI, which was associated with preoperative neurologic symptoms in 56 of 95 (58.9{\%}) patients (odds ratio = 12.92; 95{\%} confidence interval, 5.98-27.93; P <.001). Postoperative neurologic complications occurred in 24 of 195 (12.3{\%}) patients, including new ischemic stroke in 4 of 195 (2.1{\%}) and new intracerebral hemorrhage in 3 of 195 (1.5{\%}). No patients with microhemorrhages developed postoperative hemorrhage. No significant differences existed in rates of postoperative complications between patients with and those without preoperative MRI. There were no substantial associations between preoperative MRI findings and postoperative neurologic complications, functional outcomes as described by the modified Rankin Scale score, or 6-month mortality. Conclusions In patients undergoing valve replacement surgery, preoperative MRI findings were not associated with differences in postoperative outcomes, irrespective of finding or timing of valve replacement surgery.",
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