Abstract TP223: Characterizing Ischemic Stroke and Hemorrhagic Conversion in Infectious Endocarditis


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Abstract

Introduction: Ischemic stroke is a common complication of infective endocarditis (IE) and can delay valve surgery. Identifying risk factors for acute ischemic stroke (AIS) and hemorrhagic conversion may help in perioperative risk assessment of these patients.Methods: Retrospective analysis was done on 116 consecutive patients with IE seen by stroke neurology at a tertiary center from January 2015 through July 2016. Clinical and radiographic characteristics were collected in a population whose initial evaluation was for acute stroke management or preoperative risk evaluation. Descriptive statistics were used to identify risk factors for AIS, defined as clinical or silent infarct, both with and without hemorrhagic conversion.Results: Among 116 patients with IE, AIS occurred in 82 (70.6%) with a median NIH Stroke Scale of 3 (interquartile range (IQR) 0-12) and a median MRI volume of 13.5mL (IQR 1.4-42mL). Of AIS patients, 25 (30%) had silent infarct, 6 (7%) had concurrent primary ICH without a clear ischemic component and 25 (30%) had hemorrhagic conversion. AIS was associated with remote stroke on imaging (OR 1.27), history of diabetes (OR 1.22), and > 1 vegetation on echocardiogram (OR 1.29), but not history of atrial fibrillation, microhemorrhages or mycotic aneurysm on imaging, MRI enhancing lesions, aortic versus mitral valve involvement, vegetation size, organism involved, IV drug abuse, or pre-admission antithrombotic use. Microhemorrhages on MRI susceptibility-weighted images occurred in 66 (80%) AIS patients, and was associated with hemorrhagic conversion (OR 1.35). Mycotic aneurysm was found in 4 patients with hemorrhagic conversion, but this was not significant (OR 1.0). A total of 48 AIS patients (58.5%) underwent valve surgery. Additional stroke occurred while awaiting surgery in 10 AIS patients (OR 1.20), 6 were new ischemic stroke and 4 were new ICH. Post-operatively there were 1 new AIS and 3 new ICH complications.Conclusion: The incidence of acute ischemic stroke in our population was 70.6%, with a third being silent infarcts. Hemorrhagic conversion occurred in 30% and was associated with cerebral microhemorrhages.

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