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Brain imaging determinants of functional prognosis after severe endocarditis: a multicenter observational study

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Abstract

Objective

We developed a detailed imaging phenotype of the cerebral complications in critically ill patients with infective endocarditis (IE) and determine whether any specific imaging pattern could impact prognostic information.

Methods

One hundred ninety-two patients admitted to the intensive care units of seven tertiary centers with severe, definite left IE and neurological complications were included. All underwent cerebral imaging few days after admission to define the types of lesions, their volumes, and their locations using voxel-based lesion-symptom mapping (VLSM). We employed uni- and multi-variate logistic regression analyses to explore the associations among imaging features and other prognostic variables and the 6-month modified Rankin Scale (mRS) score.

Results

Ischemic lesions were the most common lesions (75%; mean volume, 15.3 ± 33 mL) followed by microbleeds (50%; mean number, 4 ± 7.5), subarachnoidal hemorrhages (20%), hemorrhagic strokes (16%; mean volume, 14.6 ± 21 mL), and hemorrhagic transformations (10%; mean volume, 5.6 ± 11 mL). The volume of hemorrhagic transformations, the severity of leukopathy, and the compromises of certain locations on the motor pathway from the VLSM were associated with a poor 6-month mRS score on univariate analyses. However, upon multivariate analyses, no such specific imaging pattern independently predicted the mRS; this was instead influenced principally by age (OR = 1.03 [1.004–1.06]) and cardiac surgery status (OR = 0.06 [0.02–0.16]) in the entire cohort, and by age (OR = 1.04 [1.01–1.08]) and Staphylococcus aureus status (OR = 2.86 [1.19–6.89]) in operated patients.

Conclusions

In a cohort of severely ill IE patients with neurological complications, no specific imaging pattern could be highlighted as a reliable predictor of prognosis.

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Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

ADC:

Apparent diffusion coefficient

DWI:

Diffusion-weighted imaging

ESC:

European Society of Cardiology

FLAIR:

Fluid-attenuated inversion recovery

ICE-COCA:

InfeCtious Endocarditis with Cerebral cOmplications: a Cohort from French reAnimations

ICU:

Intensive care unit

IE:

Infective endocarditis

IIA:

Infectious intracranial aneurysm

mRS:

Modified Rankin Scale

SAH:

Subarachnoidal hemorrhage

SOFA:

Sequential organ failure assessment

VLSM:

Voxel-based lesion symptom mapping

References

  1. Cahill TJ, Prendergast BD (2016) Infective endocarditis. Lancet 387(10021):882–893

    Article  Google Scholar 

  2. Murdoch DR et al (2009) Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 169(5):463–473

    Article  Google Scholar 

  3. Habib G et al (2015) 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 36(44):3075–3128

    Article  Google Scholar 

  4. Garcia-Cabrera E et al (2013) Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation 127(23):2272–2284

    Article  Google Scholar 

  5. Sonneville R et al (2011) Neurologic complications and outcomes of infective endocarditis in critically ill patients: the ENDOcardite en REAnimation prospective multicenter study. Crit Care Med 39(6):1474–1481

    Article  Google Scholar 

  6. Habib G et al (2019) Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J 40(39):3222–3232

    Article  Google Scholar 

  7. Iung B et al (2013) Determinants of cerebral lesions in endocarditis on systematic cerebral magnetic resonance imaging: a prospective study. Stroke 44(11):3056–3062

    Article  Google Scholar 

  8. Vogt G et al (2012) Initial lesion volume is an independent predictor of clinical stroke outcome at day 90: an analysis of the Virtual International Stroke Trials Archive (VISTA) database. Stroke 43(5):1266–1272

    Article  Google Scholar 

  9. Broderick JP et al (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24(7):987–93

    Article  CAS  Google Scholar 

  10. Wu O et al (2015) Role of acute lesion topography in initial ischemic stroke severity and long-term functional outcomes. Stroke 46(9):2438–2444

    Article  CAS  Google Scholar 

  11. Appleton JP et al (2020) Imaging markers of small vessel disease and brain frailty, and outcomes in acute stroke. Neurology 94(5):e439–e452

    Article  Google Scholar 

  12. Ryu WS et al (2017) Stroke outcomes are worse with larger leukoaraiosis volumes. Brain 140(1):158–170

    Article  Google Scholar 

  13. Kang DH et al (2012) Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 366(26):2466–2473

    Article  CAS  Google Scholar 

  14. Wilbring M et al (2014) The impact of preoperative neurological events in patients suffering from native infective valve endocarditis. Interact Cardiovasc Thorac Surg 18(6):740–747

    Article  Google Scholar 

  15. Yoshioka D et al (2012) Impact of early surgical treatment on postoperative neurologic outcome for active infective endocarditis complicated by cerebral infarction. Ann Thorac Surg 94(2):489–95; discussion 496

    Article  Google Scholar 

  16. Fazekas F et al (1987) MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol 149(2):351–6

    Article  CAS  Google Scholar 

  17. Rudilosso S et al (2017) Evaluation of white matter hypodensities on computed tomography in stroke patients using the Fazekas score. Clin Imaging 46:24–27

    Article  Google Scholar 

  18. Greenberg SM et al (2009) Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol 8(2):165–174

    Article  Google Scholar 

  19. Bates E et al (2003) Voxel-based lesion-symptom mapping. Nat Neurosci 6(5):448–450

    Article  CAS  Google Scholar 

  20. Rorden C, Karnath HO, Bonilha L (2007) Improving lesion-symptom mapping. J Cogn Neurosci 19(7):1081–1088

    Article  Google Scholar 

  21. Tzourio-Mazoyer N et al (2002) Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage 15(1):273–289

    Article  CAS  Google Scholar 

  22. Munsch F et al (2016) Stroke location is an independent predictor of cognitive outcome. Stroke 47(1):66–73

    Article  CAS  Google Scholar 

  23. Janssen PM et al (2010) Comparison of telephone and face-to-face assessment of the modified Rankin Scale. Cerebrovasc Dis 29(2):137–139

    Article  Google Scholar 

  24. Broderick JP, Adeoye O, Elm J (2017) Evolution of the modified Rankin Scale and its use in future stroke trials. Stroke 48(7):2007–2012

    Article  Google Scholar 

  25. Hess A et al (2013) Brain MRI findings in neurologically asymptomatic patients with infective endocarditis. AJNR Am J Neuroradiol 34(8):1579–1584

    Article  CAS  Google Scholar 

  26. Goulenok T et al (2013) Infective endocarditis with symptomatic cerebral complications: contribution of cerebral magnetic resonance imaging. Cerebrovasc Dis 35(4):327–336

    Article  CAS  Google Scholar 

  27. Kidwell CS et al (2004) Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 292(15):1823–1830

    Article  CAS  Google Scholar 

  28. Di Salvo G et al (2001) Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 37(4):1069–1076

    Article  Google Scholar 

  29. Johnston KC et al (2007) Validation of an acute ischemic stroke model: does diffusion-weighted imaging lesion volume offer a clinically significant improvement in prediction of outcome? Stroke 38(6):1820–1825

    Article  Google Scholar 

  30. Cheng B et al (2014) Influence of stroke infarct location on functional outcome measured by the modified rankin scale. Stroke 45(6):1695–1702

    Article  CAS  Google Scholar 

  31. Duval X et al (2010) Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med 152(8):497–504, W175

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Yves-Olivier Guettard and Alexandre Gros contributed equally to this work.

Authors and Affiliations

  1. Service de Neuroradiologie, CHU de Bordeaux, 33000, Bordeaux, France

    Yves-Olivier Guettard & Thomas Tourdias

  2. Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France

    Alexandre Gros & Alexandre Boyer

  3. INSERM-U1215, Neurocentre Magendie, 33000, Bordeaux, France

    Hikaru Fukutomi & Thomas Tourdias

  4. Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, 33000, Bordeaux, France

    Xavier Pillois

  5. Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33000, Bordeaux, France

    Benjamin Seguy

  6. Réanimation Médicale, CHU de Lille, 59000, Lille, France

    Sebastien Préau

  7. Centre Expert de La Valve, Fédération de Cardiologie, CHU de Toulouse, 31000, Toulouse, France

    Yoan Lavie-Badie

  8. Service d’Anesthésie-Réanimation, Hôpital Laënnec, CHU de Nantes, 44000, Nantes, France

    Delphine Marest

  9. Cardiologie Et Maladies Vasculaires, CHU de Rennes, 35000, Rennes, France

    Raphaël P. Martins

  10. Réanimation Médicale Polyvalente, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France

    Elisabeth Coupez

  11. Médecine Intensive Réanimation, CHU de Poitiers, 86000, Poitiers, France

    Rémi Coudroy

  12. INSERM CIC 1402, Groupe ALIVE, Université de Poitiers, 86000, Poitiers, France

    Rémi Coudroy

Authors
  1. Yves-Olivier Guettard
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  2. Alexandre Gros
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  3. Hikaru Fukutomi
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  4. Xavier Pillois
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  5. Sebastien Préau
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  6. Yoan Lavie-Badie
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  7. Delphine Marest
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  8. Raphaël P. Martins
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  9. Elisabeth Coupez
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  10. Rémi Coudroy
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  11. Benjamin Seguy
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  12. Alexandre Boyer
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  13. Thomas Tourdias
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Consortia

on behalf of the ICE-COCA investigators

  • Didier Gruson
  • , Pierre Coste
  • , Bertrand Souweine
  • , Saad Nseir
  • , Aurélia Toussaint
  • , Olivier Outteryck
  • , Jean Reignier
  • , René Robert
  • , Jean Marie Urien
  • , Lydie Porte
  • , Guillaume Robin
  • , Gaëtan Charbonnier
  • , Benjamine Sarton
  •  & Stein Silva

Contributions

T. T. and A. B. designed the study. Y. O. G., A. G., and H. F. collected the data. Y. O. G., H. F., and T. T. wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Thomas Tourdias.

Ethics declarations

Ethics approval and consent to participate

Retrospective database construction was approved by our local ethics committee (approval no. CE-SRLF-15–54) and the national data protection authority (declaration no. 2082557 v0) and complied with all dictates of the European Union General Data Protection Regulation in terms of protection of personal health data and personal information.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Pr. Boyer and Pr. Tourdias jointly directed this work and share co-senior authorship.

A complete list of ICE-COCA investigators can be found in the Appendix at the end of the manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Expanded materials and methods

Supplemental tables I and II

Supplementary file 1 (DOCX 36 KB)

Appendix

Appendix

The ICE-COCA research investigators:

Bordeaux University Hospital: Pr. BOYER Alexandre, Pr. GRUSON Didier and Dr. GROS Alexandre, Service de Médecine Intensive Réanimation, Pr. COSTE Pierre and Dr. SEGUY Benjamin, Soins intensifs de cardiologie, Hôpital Cardiologique du Haut-Lévêque, Pr. TOURDIAS Thomas and Dr. GUETTARD Yves-Olivier, Service de Neuroradiologie.

Clermont-Ferrand University Hospital: Dr. SOUWEINE Bertrand and Dr. COUPEZ Elisabeth, Médecine intensive et réanimation.

Lille University Hospital: Pr. PREAU Sébastien, Pr. NSEIR Saad and Dr. TOUSSAINT Aurélia, Réanimation médicale, Dr. OUTTERYCK Olivier, service de neuroradiologie.

Nantes University Hospital: Pr. REIGNIER Jean and Dr. MAREST Delphine, Service d’Anesthésie-Réanimation.

Poitiers University Hospital: Pr. ROBERT René and Dr. COUDROY Rémi, Médecine Intensive Réanimation.

Rennes University Hospital: Dr. MARTINS Raphaël, Cardiologie et maladies vasculaires, and Dr. URIEN Jean Marie, service de cardiologie, groupe hospitalier Bretagne sud.

Toulouse University Hospital: Dr. PORTE Lydie, Département de maladies infectieuses; Dr. LAVIE-BADIE Yoan, Dr. ROBIN Guillaume and Dr. CHARBONNIER Gaëtan, Centre expert de la valve, fédération de cardiologie; Dr. SARTON Benjamine and Pr. SILVA Stein, Réanimation polyvalente adultes.

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Guettard, YO., Gros, A., Fukutomi, H. et al. Brain imaging determinants of functional prognosis after severe endocarditis: a multicenter observational study. Neurol Sci 43, 3759–3768 (2022). https://doi.org/10.1007/s10072-021-05789-9

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