BACKGROUND: Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis. OBJECTIVE: To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults. DESIGN: Single-center prospective study between June 2005 and October 2008. (ClinicalTrials.gov registration number: NCT00144885) SETTING: Tertiary care university hospital in France. PATIENTS: 130 patients with endocarditis. INTERVENTION: Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention. MEASUREMENTS: 2 experts jointly established the endocarditis diagnostic classification (according to Duke-modified criteria) and therapeutic plans just before and after MRI and then compared them. RESULTS: Endocarditis was initially classified as definite in 77 patients and possible in 50 and was excluded in 3. Sixteen patients (12%) had acute neurologic symptoms. Cerebral lesions were detected by MRI in 106 patients (82% [95% CI, 75% to 89%]), including ischemic lesions in 68, microhemorrhages in 74, and silent aneurysms in 10. Solely on the basis of MRI results and excluding microhemorrhages, diagnostic classification of 17 of 53 (32%) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (3 patients). Endocarditis therapeutic plans were modified for 24 (18%) of the 130 patients, including surgical plan modifications for 18 (14%). Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28% [CI, 20% to 36%]). LIMITATION: Investigators did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs. CONCLUSION: Cerebral lesions were identified by MRI in many patients with endocarditis but no neurologic symptoms. The MRI findings affected both diagnostic classifications and clinical management plans. PRIMARY FUNDING SOURCE: French Ministry of Health.
BACKGROUND: Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis. OBJECTIVE: To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults. DESIGN: Single-center prospective study between June 2005 and October 2008. (ClinicalTrials.gov registration number: NCT00144885) SETTING: Tertiary care university hospital in France. PATIENTS: 130 patients with endocarditis. INTERVENTION: Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention. MEASUREMENTS: 2 experts jointly established the endocarditis diagnostic classification (according to Duke-modified criteria) and therapeutic plans just before and after MRI and then compared them. RESULTS:Endocarditis was initially classified as definite in 77 patients and possible in 50 and was excluded in 3. Sixteen patients (12%) had acute neurologic symptoms. Cerebral lesions were detected by MRI in 106 patients (82% [95% CI, 75% to 89%]), including ischemic lesions in 68, microhemorrhages in 74, and silent aneurysms in 10. Solely on the basis of MRI results and excluding microhemorrhages, diagnostic classification of 17 of 53 (32%) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (3 patients). Endocarditis therapeutic plans were modified for 24 (18%) of the 130 patients, including surgical plan modifications for 18 (14%). Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28% [CI, 20% to 36%]). LIMITATION: Investigators did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs. CONCLUSION:Cerebral lesions were identified by MRI in many patients with endocarditis but no neurologic symptoms. The MRI findings affected both diagnostic classifications and clinical management plans. PRIMARY FUNDING SOURCE: French Ministry of Health.
Authors: J Champey; P Pavese; H Bouvaist; M Maillet; A Kastler; B Boussat; P Francois Journal: Eur J Clin Microbiol Infect Dis Date: 2016-09-06 Impact factor: 3.267
Authors: Thomas L Holland; Larry M Baddour; Arnold S Bayer; Bruno Hoen; Jose M Miro; Vance G Fowler Journal: Nat Rev Dis Primers Date: 2016-09-01 Impact factor: 52.329
Authors: B Davido; A Moussiegt; A Dinh; O Senard; L Deconinck; O Auzel; X Repesse; M Sirol; M Morgan; J Salomon Journal: Eur J Clin Microbiol Infect Dis Date: 2017-07-18 Impact factor: 3.267
Authors: A Hess; I Klein; B Iung; P Lavallée; E Ilic-Habensus; Q Dornic; F Arnoult; L Mimoun; M Wolff; X Duval; J-P Laissy Journal: AJNR Am J Neuroradiol Date: 2013-05-02 Impact factor: 3.825