title: Clinical Presentation and Multi-Parametric Screening Surrogates of Ischemic Stroke Patients Suffering from Infective Endocarditis.
abstract: BACKGROUND
  Infective endocarditis (IE) represents a life-threatening condition due to complications like cardiac failure and thromboembolism. In ischemic stroke, IE formally excludes patients from approaches addressing the recanalization of occluded vessels, challenging decision-making in the early phase of hospitalization. This study aimed at the rate and clinical course of stroke patients with IE and explored clinical, imaging-based and serum parameters, which would allow early identification.
  
  
  METHODS
  A hospital-based registry containing 1,531 ischemic stroke patients was screened for IE identified by echocardiography. In addition to clinical parameters, patterns of cerebral manifestation as well as a variety of inflammatory serum and myocardial markers were analyzed concerning their predictive impact for identifying affected patients.
  
  
  RESULTS
  IE was found in 26 patients (1.7%) and was associated with an increased body temperature and cardiac murmurs. Patients suffering from IE demonstrated a more severe clinical affection at hospital discharge and an impaired symptom decline during hospitalization, further deteriorated by the use of systemic thrombolysis. Distribution of cerebral infarction patterns did not differ between the groups. C-reactive protein (CRP) and leukocyte count as well as troponin and myoglobin, taken at hospital admission, were found to be significantly associated with IE.
  
  
  CONCLUSIONS
  IE in stroke patients is associated with worse clinical outcome, complicated by intravenously applied thrombolysis, and therefore needs to be screened during the early phase of hospitalization. Increased serum levels of CRP and leukocyte count in combination with an increased body temperature or abnormal cardiac murmurs should entail rapid initiation of further diagnostics, that is, transoesophageal echocardiography.
authors.affiliation: Department of Neurology, University of Leipzig, Leipzig, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Hobohm
authors.forename: Andreas
authors.initials: A
authors.lastname: Hagendorff
authors.forename: Sandra
authors.initials: S
authors.lastname: Schulz
authors.forename: Dominik
authors.initials: D
authors.lastname: Fritzsch
authors.forename: Sarah
authors.initials: S
authors.lastname: Budig
authors.forename: Stephan
authors.initials: S
authors.lastname: Stöbe
authors.forename: Dominik
authors.initials: D
authors.lastname: Michalski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy; D002097:C-Reactive Protein / Q000378:metabolism*; D002544:Cerebral Infarction / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000097:blood / Q000150:complications / Q000175:diagnosis; D004697:Endocarditis, Bacterial / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006337:Heart Murmurs / Q000150:complications; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008403:Mass Screening; D009211:Myoglobin / Q000097:blood*; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000209:etiology; D015912:Thrombolytic Therapy; D014336:Troponin / Q000097:blood*
chemical_list: D009211:Myoglobin; D014336:Troponin; D002097:C-Reactive Protein