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Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis

From the Department of Medicine (Dr. Anderson), Department of Biostatistics and Bioinformatics and Department of Medicine (Dr. Wilkinson and L.L. Sanders), and Divisions of Infectious Diseases (Drs. Corey and Sexton) and Cardiology (Dr. Cabell), Department of Medicine, Duke University Medical Center, Durham; and Division of Neurology (Dr. Goldstein), Department of Medicine, Center for Cerebrovascular Disease, Duke University Medical Center and Durham VA Medical Center, Durham, NC.

Address correspondence and reprint requests to Dr. Daniel J. Sexton, Duke University Medical Center, Division of Infectious Diseases, Department of Medicine, Box 3605, Durham, NC 27710; e-mail: sexto002{at}mc.duke.edu

Objective: To characterize the incidence and clinical features of patients with infective endocarditis (IE) and stroke.

Methods: The authors reviewed the records of 707 patients diagnosed with definite or possible IE between January 1984 and November 1999. Stroke was confirmed by application of strict definitions and classified by type, pathophysiology, vascular territory, and severity. The authors determined mortality rates for the initial hospitalization and 12 months after admission.

Results: Strokes occurred in 68 (9.6%) of 707 patients with IE, 38 (17%) of 218 patients with mitral valve endocarditis (MVE), 14 (9%) of 149 patients with aortic valve endocarditis (AVE), and 16 (5%) of 340 patients with other forms of IE (OR for MVE vs AVE = 2.0, 95% CI 1.1 to 3.9). Among the patients with MVE or AVE and stroke, there were no significant relationships between site of vegetation and length of hospitalization, stroke severity, mortality during the initial hospitalization, or 12-month mortality. Fifty-two percent of patients with stroke and IE died within 1 year of admission.

Conclusions: The overall incidence of stroke in patients with IE (9.6%) is lower than previous reports (21 to 39%). Patients with MVE had a greater risk of stroke than patients with AVE. Fifty-two percent of patients died within 1 year of admission for IE.

Received March 10, 2003. Accepted in final form August 13, 2003.

See also page 1324

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