Short Communication| Volume 32, ISSUE 3, 106977, March 2023

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Stroke and endocarditis: Reversing the point of view. A retrospective, cohort study


      • Endocarditis prevalence in acute stroke patients is 1.0%.
      • Certain laboratory and clinical parameters are early predictors of endocarditis.
      • Patients with acute stroke and endocarditis have a poor outcome at discharge.


      Study objectives

      The primary objective of our study is to assess the endocarditis prevalence in patients admitted to the emergency department (ED) for a primary diagnosis of acute stroke (AS). Secondary objectives are the identification of early markers of endocarditis in AS patients and the analysis of the short-term outcome of this population.


      In this observational, retrospective, cohort study we enrolled consecutive adult patients with a primary diagnosis of AS admitted to the Stroke Unit or to the Neurological Intensive Care Unit of our hospital who were then discharged with a diagnosis of endocarditis. These patients were then compared with age and sex-matched controls with a diagnosis of AS and atrial fibrillation.


      Endocarditis prevalence in patients admitted to the Stroke Unit or Neurological Intensive Care Unit with a primary diagnosis of AS is 1.0% (95% confidence interval 0.61-1.55). Fever on ED admission, concomitant cancer, low hemoglobin, low lymphocyte levels, a high neutrophils count and erythrocyte sedimentation levels could early differentiate among AS patients, those with endocarditis from those with atrial fibrillation. A moderate-to-severe valvular regurgitation is strongly suggestive of endocarditis. The short term-outcome is markedly worse in endocarditis patients compared to patients with atrial fibrillation, in terms of in-hospital mortality and discharge disability.


      Endocarditis prevalence in patients admitted for a primary diagnosis of AS is low, but this etiology leads to a poor outcome. Some laboratory, clinical-epidemiological and echocardiographic parameters may help the physician to early recognize this condition and, consequently, to promptly start an antibiotic therapy.


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        • Cao GF
        • Liu W
        • Bi Q.
        Stroke in patients with infective endocarditis: a 15-year single-center cohort study.
        Eur Neurol. 2018; 80: 171-178
        • Hobohm C
        • Hagendorff A
        • Schulz S
        • et al.
        Clinical presentation and multi-parametric screening surrogates of ischemic stroke patients suffering from infective endocarditis.
        Cerebrovasc Dis. 2016; 41: 60-67
        • Reid KA
        • Barlasm RS
        • Mamas MA
        • et al.
        Infective endocarditis is associated with worse outcomes in stroke: a Thailand National Database Study.
        Int J Clin Pract. 2020; 74: e13614
        • Habib G
        • Lancellotti P
        • Antunes MJ
        • et al.
        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. 2015; 36: 3075-3128
        • Derex L
        • Bonnefoy E
        • Delahaye F.
        Impact of stroke on therapeutic decision making in infective endocarditis.
        J Neurol. 2010; 257: 315-321
        • Arboix A
        • Alio J.
        Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis.
        Curr Cardiol Rev. 2010; 6: 150-161
        • Hogevik H
        • Olaison L
        • Andersson R
        • et al.
        C-reactive protein is more sensitive than erythrocyte sedimentation rate for diagnosis of infective endocarditis.
        Infection. 1997; 25: 82-85
        • Chung MK
        • Martin DO
        • Sprecher D
        • et al.
        C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation.
        Circulation. 2001; 104: 2886-2891
        • Lip GY
        • Patel JV
        • Hughes E
        • et al.
        High-sensitivity C-reactive protein and soluble CD40 ligand as indices of inflammation and platelet activation in 880 patients with nonvalvular atrial fibrillation: relationship to stroke risk factors, stroke risk stratification schema, and prognosis.
        Stroke. 2007; 38: 1229-1237
        • Fumagalli S
        • Tarantini F
        • Guarducci L
        • et al.
        Atrial fibrillation is a possible marker of frailty in hospitalized patients: results of the GIFA study.
        Aging Clin Exp Res. 2010; 22: 129-133
        • Garcia-Albeniz X
        • Hsu J
        • Lipsitch M
        • et al.
        Infective endocarditis and cancer in the elderly.
        Eur J Epidemiol. 2016; 31: 41-49
        • Bai AD
        • Steinberg M
        • Showler A
        • et al.
        Diagnostic accuracy of transthoracic echocardiography for infective endocarditis findings using transesophageal echocardiography as the reference standard: a meta-analysis.
        J Am Soc Echocardiogr. 2017; 30 (e638): 639-646
        • Cabell CH
        • Pond KK
        • Peterson GE
        • et al.
        The risk of stroke and death in patients with aortic and mitral valve endocarditis.
        Am Heart J. 2001; 142: 75-80
        • Asaithambi G
        • Adil MM
        • Qureshi AI.
        Thrombolysis for ischemic stroke associated with infective endocarditis: results from the nationwide inpatient sample.
        Stroke. 2013; 44: 2917-2919
        • Marnat G
        • Sibon I
        • Gory B
        • et al.
        Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: a case-control study.
        Int J Stroke. 2021; 16: 585-592
        • Dickerman SA
        • Abrutyn E
        • Barsic B
        • et al.
        The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS).
        Am Heart J. 2007; 154: 1086-1094