Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions

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

Research output: Contribution to journalArticle

Abstract

Objective: To determine how brain magnetic resonance imaging (MRI)findings impact clinical outcomes in patients with infective endocarditis (IE)and to propose a management algorithm for patients with neurologic symptoms who are candidates for valve surgery (VS). Patients and Methods: Data from our center were retrospectively reviewed for patients hospitalized with IE between January 1, 2007, and December 31, 2014. Outcomes were postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcome at last follow-up as described by the modified Rankin Scale (mRS)score. Good outcome was defined as an mRS score of 2 or less. Results: A total of 361 patients with IE were identified, including 127 patients (35%)who had MRI. One hundred twenty-six of 361 patients (35%)had neurologic symptoms, which prompted MRI in 79 of 127 patients (62%); 74 of 79 (94%)had acute or subacute MRI abnormalities. One patient with subarachnoid and multifocal ICH on MRI developed postoperative ICH. Patients with VS despite MRI abnormalities had lower 6-month mortality (odds ratio [OR], 0.17; 95% CI, 0.06-0.48; P<.001)and better functional outcome (OR, 4.43; 95% CI, 1.51-13.00; P=.005). Irrespective of VS, lobar or posterior fossa ICH on MRI was associated with 6-month mortality (OR, 3.58; 95% CI, 1.22-10.50; P=.02)and territorial ischemic stroke was inversely associated with good mRS (OR, 0.29; 95% CI, 0.13-0.66; P=.002). In neurologically asymptomatic patients who had VS, MRI findings did not impact 6-month mortality or functional outcomes. Conclusion: Magnetic resonance imaging detects a large number of abnormalities in patients with IE. Preoperative lobar hematoma and large territorial stroke determine outcome irrespective of VS. When indicated, VS increases the odds of a good outcome despite MRI abnormalities.

Original languageEnglish (US)
Pages (from-to)1024-1032
Number of pages9
JournalMayo Clinic proceedings
Volume94
Issue number6
DOIs
StatePublished - Jun 1 2019

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Endocarditis
Magnetic Resonance Imaging
Brain
Cerebral Hemorrhage
Odds Ratio
Postoperative Hemorrhage
Mortality
Neurologic Manifestations
Stroke
Intracranial Hemorrhages
Hematoma

ASJC Scopus subject areas

  • Medicine(all)

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Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions. / Chakraborty, Tia; Scharf, Eugene; DeSimone, Daniel; El Rafei, Abdelghani; Brinjikji, Waleed; Baddour, Larry M.; Wilson, Walter; Steckelberg, James M.; Fugate, Jennifer E.; Wijdicks, Eelco F.M.; Rabinstein, Alejandro.

In: Mayo Clinic proceedings, Vol. 94, No. 6, 01.06.2019, p. 1024-1032.

Research output: Contribution to journalArticle

Chakraborty, T, Scharf, E, DeSimone, D, El Rafei, A, Brinjikji, W, Baddour, LM, Wilson, W, Steckelberg, JM, Fugate, JE, Wijdicks, EFM & Rabinstein, A 2019, 'Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions', Mayo Clinic proceedings, vol. 94, no. 6, pp. 1024-1032. https://doi.org/10.1016/j.mayocp.2018.09.015
Chakraborty, Tia ; Scharf, Eugene ; DeSimone, Daniel ; El Rafei, Abdelghani ; Brinjikji, Waleed ; Baddour, Larry M. ; Wilson, Walter ; Steckelberg, James M. ; Fugate, Jennifer E. ; Wijdicks, Eelco F.M. ; Rabinstein, Alejandro. / Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions. In: Mayo Clinic proceedings. 2019 ; Vol. 94, No. 6. pp. 1024-1032.
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abstract = "Objective: To determine how brain magnetic resonance imaging (MRI)findings impact clinical outcomes in patients with infective endocarditis (IE)and to propose a management algorithm for patients with neurologic symptoms who are candidates for valve surgery (VS). Patients and Methods: Data from our center were retrospectively reviewed for patients hospitalized with IE between January 1, 2007, and December 31, 2014. Outcomes were postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcome at last follow-up as described by the modified Rankin Scale (mRS)score. Good outcome was defined as an mRS score of 2 or less. Results: A total of 361 patients with IE were identified, including 127 patients (35{\%})who had MRI. One hundred twenty-six of 361 patients (35{\%})had neurologic symptoms, which prompted MRI in 79 of 127 patients (62{\%}); 74 of 79 (94{\%})had acute or subacute MRI abnormalities. One patient with subarachnoid and multifocal ICH on MRI developed postoperative ICH. Patients with VS despite MRI abnormalities had lower 6-month mortality (odds ratio [OR], 0.17; 95{\%} CI, 0.06-0.48; P<.001)and better functional outcome (OR, 4.43; 95{\%} CI, 1.51-13.00; P=.005). Irrespective of VS, lobar or posterior fossa ICH on MRI was associated with 6-month mortality (OR, 3.58; 95{\%} CI, 1.22-10.50; P=.02)and territorial ischemic stroke was inversely associated with good mRS (OR, 0.29; 95{\%} CI, 0.13-0.66; P=.002). In neurologically asymptomatic patients who had VS, MRI findings did not impact 6-month mortality or functional outcomes. Conclusion: Magnetic resonance imaging detects a large number of abnormalities in patients with IE. Preoperative lobar hematoma and large territorial stroke determine outcome irrespective of VS. When indicated, VS increases the odds of a good outcome despite MRI abnormalities.",
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T1 - Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions

AU - Chakraborty, Tia

AU - Scharf, Eugene

AU - DeSimone, Daniel

AU - El Rafei, Abdelghani

AU - Brinjikji, Waleed

AU - Baddour, Larry M.

AU - Wilson, Walter

AU - Steckelberg, James M.

AU - Fugate, Jennifer E.

AU - Wijdicks, Eelco F.M.

AU - Rabinstein, Alejandro

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N2 - Objective: To determine how brain magnetic resonance imaging (MRI)findings impact clinical outcomes in patients with infective endocarditis (IE)and to propose a management algorithm for patients with neurologic symptoms who are candidates for valve surgery (VS). Patients and Methods: Data from our center were retrospectively reviewed for patients hospitalized with IE between January 1, 2007, and December 31, 2014. Outcomes were postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcome at last follow-up as described by the modified Rankin Scale (mRS)score. Good outcome was defined as an mRS score of 2 or less. Results: A total of 361 patients with IE were identified, including 127 patients (35%)who had MRI. One hundred twenty-six of 361 patients (35%)had neurologic symptoms, which prompted MRI in 79 of 127 patients (62%); 74 of 79 (94%)had acute or subacute MRI abnormalities. One patient with subarachnoid and multifocal ICH on MRI developed postoperative ICH. Patients with VS despite MRI abnormalities had lower 6-month mortality (odds ratio [OR], 0.17; 95% CI, 0.06-0.48; P<.001)and better functional outcome (OR, 4.43; 95% CI, 1.51-13.00; P=.005). Irrespective of VS, lobar or posterior fossa ICH on MRI was associated with 6-month mortality (OR, 3.58; 95% CI, 1.22-10.50; P=.02)and territorial ischemic stroke was inversely associated with good mRS (OR, 0.29; 95% CI, 0.13-0.66; P=.002). In neurologically asymptomatic patients who had VS, MRI findings did not impact 6-month mortality or functional outcomes. Conclusion: Magnetic resonance imaging detects a large number of abnormalities in patients with IE. Preoperative lobar hematoma and large territorial stroke determine outcome irrespective of VS. When indicated, VS increases the odds of a good outcome despite MRI abnormalities.

AB - Objective: To determine how brain magnetic resonance imaging (MRI)findings impact clinical outcomes in patients with infective endocarditis (IE)and to propose a management algorithm for patients with neurologic symptoms who are candidates for valve surgery (VS). Patients and Methods: Data from our center were retrospectively reviewed for patients hospitalized with IE between January 1, 2007, and December 31, 2014. Outcomes were postoperative intracerebral hemorrhage (ICH), 6-month mortality, and functional outcome at last follow-up as described by the modified Rankin Scale (mRS)score. Good outcome was defined as an mRS score of 2 or less. Results: A total of 361 patients with IE were identified, including 127 patients (35%)who had MRI. One hundred twenty-six of 361 patients (35%)had neurologic symptoms, which prompted MRI in 79 of 127 patients (62%); 74 of 79 (94%)had acute or subacute MRI abnormalities. One patient with subarachnoid and multifocal ICH on MRI developed postoperative ICH. Patients with VS despite MRI abnormalities had lower 6-month mortality (odds ratio [OR], 0.17; 95% CI, 0.06-0.48; P<.001)and better functional outcome (OR, 4.43; 95% CI, 1.51-13.00; P=.005). Irrespective of VS, lobar or posterior fossa ICH on MRI was associated with 6-month mortality (OR, 3.58; 95% CI, 1.22-10.50; P=.02)and territorial ischemic stroke was inversely associated with good mRS (OR, 0.29; 95% CI, 0.13-0.66; P=.002). In neurologically asymptomatic patients who had VS, MRI findings did not impact 6-month mortality or functional outcomes. Conclusion: Magnetic resonance imaging detects a large number of abnormalities in patients with IE. Preoperative lobar hematoma and large territorial stroke determine outcome irrespective of VS. When indicated, VS increases the odds of a good outcome despite MRI abnormalities.

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