title: Determinants of cerebral lesions in endocarditis on systematic cerebral magnetic resonance imaging: a prospective study.
abstract: OBJECTIVE
  Cerebral lesions are frequent complications of infective endocarditis (IE) and have a prognostic impact. Cerebral MRI identifies lesions in a high number of patients. However, their determinants have not been identified. The aim of the study was to define the determinants of cerebral lesions in patients with IE undergoing systematic cerebral MRI.
  
  
  METHODS
  Determinants of ischemic lesions and of microbleeds were prospectively analyzed in 120 patients with left-sided IE, using systematic cerebral MRI.
  
  
  RESULTS
  Median age was 60 years (interquartile range 51-72); IE occurred on a prosthetic valve in 37 patients (30.8%) and was due to Streptococci in 47 patients and Staphylococci in 36; 15 (12.5%) had neurological symptoms. MRI detected ischemic lesions in 64 patients (53.3%; territorial lesions in 32 and small lesions in 57) and microbleeds in 72 (60.0%). In multivariate analysis, ischemic lesions were associated with vegetation length (odds ratio 1.10/mm; 95% confidence interval 1.03-1.16; P=0.003) and Staphylococcus aureus IE (odds ratio 2.65; 95% confidence interval 1.01-6.96; P=0.05). A vegetation length >4 mm identified ischemic lesions with a sensitivity of 74.6% and a specificity of 51.5%. Microbleeds were associated with prosthetic IE (odds ratio 8.01; 95% confidence interval 2.58-24.90; P=0.0003) and not with prior anticoagulant therapy (P=0.67).
  
  
  CONCLUSIONS
  Systematic cerebral MRI frequently detects ischemic lesions and microbleeds during acute IE. The high sensitivity of MRI shows that each millimeter increase in vegetation length is associated with a 10% increase in the rate of ischemic lesions. Conversely, microbleeds are associated only with prosthetic IE in this study.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00144885.
authors.affiliation: From the Departments of Cardiology (B.I., D.M.-Z., E.B.), Biostatistic (S.T.), Radiology (I.K.), Cardiovascular Surgery (L.L., N.A.-A.), Microbiology (R.R.), Intensive Care (M.W.), and Infectious Disease (X.D.), AP-HP, Bichat Hospital, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France (B.I., R.R., C.L., M.W., X.D.); INSERM Clinical Investigation Center 007, Paris, France (S.T., X.D.); and INSERM U738, Paris, France (C.L., X.D.).
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Sarah
authors.initials: S
authors.lastname: Tubiana
authors.forename: Isabelle
authors.initials: I
authors.lastname: Klein
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Laurent
authors.initials: L
authors.lastname: Lepage
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.forename: Raymond
authors.initials: R
authors.lastname: Ruimy
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis*; D004452:Echocardiography; D004696:Endocarditis / Q000150:complications*; D005260:Female; D006350:Heart Valve Prosthesis / Q000382:microbiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis; D013290:Streptococcal Infections / Q000175:diagnosis
keywords: echocardiography; endocarditis; microbleeds; stroke