Clinical study of stroke in young adults with infective endocarditis

Abstract

To investigate the clinical features of stroke in young adults with infective endocarditis (IE). This is a retrospective analysis of clinical data of young patients (aged between 18 and 44 years) diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013. Three hundred IE patients (209 male and 91 female) were enrolled with mean age of (31.8 ± 7.8) years old. Fourteen of them were prosthetic valve endocarditis. All of the cases were found vegetations. The vegetations were mainly distributed in the mitral valve and/or aortic valve (262/300 patients). Congenital heart disease and rheumatic valvular disease were most frequently background diseases. Thirty-five cases (11.7%) were complicated with stroke. Among them, 21 cases were with cerebral infarction (including 7 subjects with hemorrhagic transformation), 9 cases with cerebral hemorrhage, 3 cases with subarachnoid hemorrhage, and 2 with reasons unknown. Within the 21 cerebral infarction cases, the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems. As to the cerebral hemorrhage, lobar were the bleeding sites in all cases, and mainly distributed in internal carotid artery system. The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0% (35/35) vs 86.4% (229/265), P = 0.02; 22.8% (8/35) vs 6.4% (17/265), P = 0.001, respectively]. Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 (95% CI 1.626-15.072), and the OR of stroke for death was 8.387 (95% CI 1.997-35.225), respectively. Stroke is common in young patients with IE. Cerebral infarction often involves multiple vascular systems, and is prone to hemorrhagic transformation. Intracerebral hemorrhage often occurs in lobar. Rheumatic valvular disease might be a risk factor for stroke in young patients with IE, which is an independent risk factor for death of these patients.