Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis

Christine Selton-Suty (1) , François Delahaye (2) , Pierre Tattevin (3, 4) , Claire Federspiel (5) , Vincent Le Moing (6, 7) , Catherine Chirouze (8, 9, 10) , Pierre Nazeyrollas (11) , Véronique Vernet-Garnier (11) , Yvette Bernard (12) , Sidney Chocron (13) , Jean-Francois Obadia (14) , François Alla (15, 16) , Bruno Hoen (17) , Xavier Duval (18, 19)

1 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
2 Hopital Cardio-Thoracique et Vasculaire Louis Pradel
3 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
4 Fonction, structure et inactivation d'ARN bactériens
5 CH Départemental Vendée
6 CHU de Montpellier
7 TransVIHMI - Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes
8 LCE - Laboratoire Chrono-environnement (UMR 6249)
9 Service des maladies infectieuses et tropicales
10 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
11 Hôpital universitaire Robert Debré [Reims]
12 Service de cardiologie [CHRU de Besançon]
13 Service de Chirurgie Cardiaque [CHU Besançon]
14 Service de chirurgie cardiaque
15 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
16 Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy
17 CHU Pointe-à-Pitre/Abymes [Guadeloupe]
18 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
19 CIC Hôpital Bichat

Objectives: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.

Mots clés: embolism; diagnosis; guidelines; multicenter; cerebrovascular complications; cardiac-surgery

Domaines: Maladies infectieuses; Cardiologie et système cardiovasculaire; Neurobiologie; Santé publique et épidémiologie

Christine Selton-Suty, François Delahaye, Pierre Tattevin, Claire Federspiel, Vincent Le Moing, et al.. Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis. PLoS ONE, 2016, 11 (7), pp.e0158522. ⟨10.1371/journal.pone.0158522⟩. ⟨hal-01362655⟩