Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis.
BACKGROUND
Brain magnetic resonance imaging (MRI) is frequently obtained in patients with infective endocarditis, yet its utility in predicting outcomes for valve replacement surgery in patients is unknown. The objective of this study was to determine how brain MRI findings impact clinical management and outcomes.


METHODS
Demographic and clinical data from electronic medical records at Mayo Clinic were retrospectively reviewed for patients hospitalized with definite or possible infective endocarditis according to the modified Duke criteria between January 1, 2007 and December 31, 2014. There were 364 patients included in the study.


RESULTS
Cardiac valve replacement surgery was performed in 195 of 364 (53.6%) patients, and 95 (48.7%) of the surgical patients underwent preoperative MRI, which was associated with preoperative neurologic symptoms in 56 of 95 (58.9%) patients (odds ratio = 12.92; 95% confidence interval, 5.98-27.93; P <.001). Postoperative neurologic complications occurred in 24 of 195 (12.3%) patients, including new ischemic stroke in 4 of 195 (2.1%) and new intracerebral hemorrhage in 3 of 195 (1.5%). No patients with microhemorrhages developed postoperative hemorrhage. No significant differences existed in rates of postoperative complications between patients with and those without preoperative MRI. There were no substantial associations between preoperative MRI findings and postoperative neurologic complications, functional outcomes as described by the modified Rankin Scale score, or 6-month mortality.


CONCLUSIONS
In patients undergoing valve replacement surgery, preoperative MRI findings were not associated with differences in postoperative outcomes, irrespective of finding or timing of valve replacement surgery.
['Chakraborty|Tia|T|', 'Scharf|Eugene|E|', 'Rabinstein|Alejandro A|AA|', 'DeSimone|Daniel|D|', 'El Rafei|Abdelghani|A|', 'Brinjikji|Waleed|W|', 'Baddour|Larry M|LM|', 'Wijdicks|Eelco|E|', 'Wilson|Walter|W|', 'Steckelberg|James M|JM|', 'Fugate|Jennifer E|JE|']
D000328:Adult D000368:Aged D001921:Brain D006348:Cardiac Surgical Procedures D004696:Endocarditis D005260:Female D006801:Humans D007091:Image Processing, Computer-Assisted D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D016896:Treatment Outcome
Endocarditis MRI surgery stroke hemorrhage