Impact of routine brain imaging on the prognosis of patients with left-sided valve infective endocarditis without neurological manifestations
Copyright © 2023 Elsevier B.V. All rights reserved..
BACKGROUND: There are limited data on the impact of routine use of brain magnetic resonance imaging (MRI) on the prognosis of neurologically asymptomatic patients with left-sided infective endocarditis (IE).
METHODS: Among patients diagnosed with possible or definite IE in two tertiary referral centers between January 2005 and March 2019, we identified 527 left-sided IE patients without neurological symptoms or signs at the time of diagnosis. Patients who underwent brain MRI within 1 week after the IE diagnosis were classified as the routine brain imaging group (n = 216), and the rest were categorized as the control group (n = 311). All-cause mortality at 3 months, attributable mortality (defined as death directly related to IE), and fatal neurological events compared after adjustment using inverse probability of treatment weighting (IPTW).
RESULTS: During a median follow-up of 57 months, the routine brain imaging group had a similar risk of 3-month all-cause mortality to the control group in the multivariate analysis (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.24-1.14) and IPTW-adjusted cohort (HR, 0.59; 95% CI, 0.25-1.42). The risks of attributable mortality and fatal neurological events were also similar between the two groups in the multivariable analysis and IPTW-adjusted cohort. In the subgroup analysis, the routine brain imaging group showed more favorable outcomes in cases of large vegetation (> 10 mm) or acute-onset microorganisms.
CONCLUSIONS: Routine use of brain MRI in left-sided IE patients without neurological manifestations is not associated with improved clinical outcomes. However, routine brain imaging in appropriate clinical settings could improve clinical outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:389 |
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| Enthalten in: |
International journal of cardiology - 389(2023) vom: 15. Okt., Seite 131175 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Oh, Jin Kyung [VerfasserIn] |
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| Links: |
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| Themen: |
Brain imaging |
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| Anmerkungen: |
Date Completed 08.09.2023 Date Revised 16.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ijcard.2023.131175 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359431305 |
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| 100 | 1 | |a Oh, Jin Kyung |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impact of routine brain imaging on the prognosis of patients with left-sided valve infective endocarditis without neurological manifestations |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier B.V. All rights reserved. | ||
| 520 | |a BACKGROUND: There are limited data on the impact of routine use of brain magnetic resonance imaging (MRI) on the prognosis of neurologically asymptomatic patients with left-sided infective endocarditis (IE) | ||
| 520 | |a METHODS: Among patients diagnosed with possible or definite IE in two tertiary referral centers between January 2005 and March 2019, we identified 527 left-sided IE patients without neurological symptoms or signs at the time of diagnosis. Patients who underwent brain MRI within 1 week after the IE diagnosis were classified as the routine brain imaging group (n = 216), and the rest were categorized as the control group (n = 311). All-cause mortality at 3 months, attributable mortality (defined as death directly related to IE), and fatal neurological events compared after adjustment using inverse probability of treatment weighting (IPTW) | ||
| 520 | |a RESULTS: During a median follow-up of 57 months, the routine brain imaging group had a similar risk of 3-month all-cause mortality to the control group in the multivariate analysis (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.24-1.14) and IPTW-adjusted cohort (HR, 0.59; 95% CI, 0.25-1.42). The risks of attributable mortality and fatal neurological events were also similar between the two groups in the multivariable analysis and IPTW-adjusted cohort. In the subgroup analysis, the routine brain imaging group showed more favorable outcomes in cases of large vegetation (> 10 mm) or acute-onset microorganisms | ||
| 520 | |a CONCLUSIONS: Routine use of brain MRI in left-sided IE patients without neurological manifestations is not associated with improved clinical outcomes. However, routine brain imaging in appropriate clinical settings could improve clinical outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Brain imaging | |
| 650 | 4 | |a Infective endocarditis | |
| 650 | 4 | |a Neurological manifestation | |
| 700 | 1 | |a Jung, Jongtak |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Seung-Ah |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Sahmin |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Eun-Jae |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Euijin |e verfasserin |4 aut | |
| 700 | 1 | |a Kang, Chang Kyoung |e verfasserin |4 aut | |
| 700 | 1 | |a Choe, Pyoeng Gyun |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Yong-Jin |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Nam Joong |e verfasserin |4 aut | |
| 700 | 1 | |a Song, Jong-Min |e verfasserin |4 aut | |
| 700 | 1 | |a Kang, Duk-Hyun |e verfasserin |4 aut | |
| 700 | 1 | |a Song, Jae-Kwan |e verfasserin |4 aut | |
| 700 | 1 | |a Oh, Myoung-Don |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Wan Beom |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Dae-Hee |e verfasserin |4 aut | |
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