title: Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis.
abstract: OBJECTIVE
  Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE.
  
  
  METHODS
  From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation.
  
  
  RESULTS
  Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality.
  
  
  CONCLUSIONS
  The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results.
authors.affiliation: Cardiologie, CHU Nancy-Brabois, 54511, Nancy, France.
authors.forename: Christine
authors.identifier: http://orcid.org/0000-0003-4129-5784
authors.initials: C
authors.lastname: Selton-Suty
authors.affiliation: Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon; Université Claude Bernard, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Cardiologie, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Federspiel
authors.affiliation: Maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire; UMI 233 Institut de Recherche sur le Développement, Université de Montpellier, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.affiliation: UMR 6249 Laboratoire Chrono-environnement, université de Franche-Comté; Maladies infectieuses et tropicales, Centre Hospitalier Universitaire, Besançon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.affiliation: Cardiologie, Centre Hospitalier Universitaire, Reims, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Nazeyrollas
authors.affiliation: Microbiologie, Centre Hospitalier Universitaire, Reims, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Vernet-Garnier
authors.affiliation: Cardiologie, Centre Hospitalier Universitaire, Besançon, France.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Bernard
authors.affiliation: Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.affiliation: Uninté INSERM 886 « cardioprotection », laboratoire de physiologie Lyon nord, UCBL1; Hôpital Louis Pradel-Chirurgie Cardiothoracique et Transplantation, Lyon, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Obadia
authors.affiliation: Université de Lorraine, Université Paris Descartes, Apemac, EA4360; INSERM, CIC-EC, CIE6, Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: Maladies infectieuses et tropicales, Centre Hospitalier Universitaire, Point à Pitre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.affiliation: Inserm CIC 1425, AP-HP, Hôpital Universitaire Bichat; Inserm U1137 IAME; Université Paris Diderot, Paris 7, UFR de Médecine-Bichat, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
mesh_terms: D058070:Asymptomatic Diseases; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications*; D011379:Prognosis