title: In-hospital mortality risk factors for patients with cerebral vascular events in infectious endocarditis. A correlative study of clinical, echocardiographic, microbiologic and neuroimaging findings.
abstract: OBJECTIVE
  Cardiac complications in infectious endocarditis (IE) are seen in nearly 50% of cases, and systemic complications may occur. The aim of the present study was to determine the characteristics of inpatients with IE who suffered acute neurologic complications and the factors associated with early mortality.
  
  
  METHODS
  From January 2004 to May 2010, we reviewed clinical and imaging charts of all of the patients diagnosed with IE who presented a deficit suggesting a neurologic complication evaluated with Computed Tomography or Magnetic Resonance within the first week. This was a descriptive and retrolective study.
  
  
  RESULTS
  Among 325 cases with IE, we included 35 patients (10.7%) [19 males (54%), mean age 44-years-old]. The most common underlying cardiac disease was rheumatic valvulopathy (n=8, 22.8%). Twenty patients survived (57.2%, group A) and 15 patients died (42.8%, group B) during hospitalization. The main cause of death was septic shock (n=7, 20%). There was no statistical difference among groups concerning clinical presentation, vegetation size, infectious agent and vascular territory. The overall number of lesions was significantly higher in group B (3.1 vs. 1.6, p=0.005) and moderate to severe cerebral edema were more frequent (p=0.09). Sixteen patients (45.7%) (12 in group A and 4 in group B, p=0.05) were treated by cardiac surgery. Only two patients had a favorable outcome with conservative treatment (5.7%).
  
  
  CONCLUSIONS
  In patients with IE complicated with stroke, the number of lesions observed in neuroimaging examinations and conservative treatment were associated with higher in-hospital mortality.
authors.affiliation: Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., Mexico. Electronic address: dra_glezmelchor@hotmail.com.
authors.forename: Laila
authors.initials: L
authors.lastname: González-Melchor
authors.affiliation: Departamento de Radiología e Imagen, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., Mexico.
authors.forename: Eric
authors.initials: E
authors.lastname: Kimura-Hayama
authors.affiliation: Departamento de Radiología e Imagen, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., Mexico.
authors.forename: Mariana
authors.initials: M
authors.lastname: Díaz-Zamudio
authors.affiliation: Departamento de Neuroradiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico.
authors.forename: Jesús
authors.initials: J
authors.lastname: Higuera-Calleja
authors.affiliation: Departamento de Radiología e Imagen, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., Mexico.
authors.forename: Cinthia
authors.initials: C
authors.lastname: Choque
authors.affiliation: Departamento de Infectología, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F., Mexico.
authors.forename: Gabriel I
authors.initials: GI
authors.lastname: Soto-Nieto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality*; D014463:Ultrasonography; D055815:Young Adult
keywords: Accidente cerebrovascular; Echocardiography; Ecocardiografía; Endocarditis; Imagen; Imaging; Mexico; México; Stroke; Valves; Válvulas