Abstract Body: Introduction: Stroke is a devastating complication of infective endocarditis (IE) and is associated with poor outcomes. The underlying factors contributing to stroke in IE are not yet fully understood, leaving gaps in optimizing disease management and preventive strategies. In this study, we analyzed the radiological characteristics, functional outcomes and predictors of poor outcome in patients who developed acute stroke following a diagnosis of infective endocarditis.
Methods: We conducted a retrospective study of patients diagnosed with infective endocarditis at a single tertiary center over a 10-year period from 2014 to 2023. Out of 526 cases, 511 had active infection and were screened for acute stroke associated with IE. We recorded baseline characteristics including age, gender, comorbidities, echocardiographic findings, vegetation location, microbiological profile, stroke type with radiological features, treatment strategies, and functional outcomes assessed by the Modified Rankin Scale (mRS). Descriptive statistical analysis was performed using IBM SPSS v.20, focusing on predictors of poor outcomes from radiological, microbiological, and echocardiographic data.
Results: Among 511 patients with active IE, 13.3% (68) developed acute stroke, with 80.88% (55) being male. The mitral valve was the most common site for vegetations (66.12%, 41/62). Most cases were culture-negative (39.7%, 27/68), followed by Streptococci (11.76%, 8/68) and Enterococci (10.29%, 7/68). Ischemic strokes accounted for 77.94% of cases, while hemorrhagic strokes occurred in 22.05% (n=68). The middle cerebral artery (MCA) was most frequently affected (54.72%, 29/53). Hemorrhagic transformation was observed in 20.05% of stroke cases. Among hemorrhagic strokes, subdural hemorrhage occurred in 13.3% (2/15) and subarachnoid hemorrhage in 20% (3/15). A favorable outcome (mRS 0-2) was achieved in 41.17% of patients, while 58.82% had poor outcomes (mRS 3-6). The overall mortality rate was 33.82% (23/68), with 69.56% (16/23) of deceased patients having ischemic strokes, often involving the MCA territory (43.76%, 7/16).
Conclusion: Our findings show that patients with ischemic stroke and IE face higher mortality rates. We observed that most strokes occurred in patients with vegetations on native mitral valves. These results emphasize the need for careful monitoring and effective treatment strategies for patients with native valve endocarditis to reduce stroke risk and improve outcomes.