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Stroke in patients with prosthetic valve endocarditis

Single-center cohort study in China

Schlaganfall bei Patienten mit Klappenprothesenendokarditis

Einzelzentrum-Kohortenstudie in China

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An Erratum to this article was published on 28 May 2019

This article has been updated

Abstract

Background

This study summarizes the clinical features of stroke in patients with prosthetic valve endocarditis (PVE) in China.

Methods

The clinical data of PVE patients admitted to Beijing Anzhen Hospital from January 1997 to August 2018 were retrospectively analyzed.

Results

In total, 62 patients with PVE were enrolled (45 males, 17 females). The patients’ age ranged from 23 to 79 years (51.69 ± 15.01). Rheumatic heart disease (RHD) was the most common reason for valve replacement. Of the patients, 58 were found to have vegetations by echocardiography. Blood cultures revealed the most common pathogens to be Staphylococcus (12 cases) and fungal infections (n = 7); 18 (29.03%) patients had strokes. There were 12 cases of ischemic stroke, three cases of cerebral hemorrhage, one case of subarachnoid hemorrhage, and two cases of unclear etiology. The most commonly found clinical symptoms of stroke patients were hemiplegia (n = 10) and coma (n = 5). The five patients in coma died during hospitalization. The incidence of RHD, double valve replacement, atrial fibrillation, and mitral valve vegetation was significantly higher in the stroke group than in the non-stroke group (p = 0.045, 0.000, 0.033, and 0.045, respectively). Logistic regression analysis showed that the odds ratios (ORs) for RHD, double valve replacement, and fungal infection as risk factors of stroke were 7.26 (95% CI: 1.23–42.68), 25.60 (95%CI: 4.33–126.16), and 20.58 (95% CI: 2.13–198.82), respectively, and were statistically significant. Eight patients died during hospitalization and the in-hospital mortality was 12.90%. The OR for in-hospital mortality with concurrent stroke was 5.13 (95% CI: 1.08–24.46, p = 0.028).

Conclusion

Stroke is a common complication in PVE that increases patient mortality. Rheumatic heart disease, double valve replacement, and fungal infection may be risk factors for patients with PVE complicated by stroke.

Zusammenfassung

Hintergrund

Der vorliegende Beitrag stellt klinische Merkmale des Schlaganfalls bei Patienten in China mit Klappenprothesenendokarditis (KPE) dar.

Methoden

Retrospektiv wurden von Januar 1997 bis August 2018 die klinischen Daten von KPE-Patienten, die ins Beijing Anzhen Hospital aufgenommen wurden, analysiert.

Ergebnisse

Insgesamt wurden 62 Patienten mit KPE in die Analyse einbezogen (45 m., 17 w.). Das Alter der Patienten betrug 23–79 Jahre (51,69 ± 15,01). Häufigster Grund für den Klappenersatz war eine rheumatische Herzerkrankung („rheumatic heart disease“, RHD). Bei 58 der Patienten wurden echokardiographisch Vegetationen festgestellt. Blutkulturen ergaben als häufigste Pathogene Staphylococcus (12 Fälle) und Pilzinfektionen (n = 7); 18 (29,03%) Patienten hatten einen Schlaganfall. Es gab 12 Fälle mit ischämischem Schlaganfall, 3 Fälle mit Zerebralblutung, einen Fall mit Subarachnoidalblutung und 2 Fälle unklarer Ätiologie. Häufigste klinische Symptome der Schlaganfallpatienten waren Hemiplegie (n = 10) und Koma (n = 5). Die 5 Patienten im Koma starben während der stationären Behandlung. Die Inzidenz von RHD, doppeltem Klappenersatz, Vorhofflimmern und Mitralklappenvegetationen war in der Schlaganfallgruppe signifikant höher als in der Gruppe ohne Schlaganfall (p =0,045; 0,000; 0,033 bzw. 0,045). Die logistische Regressionsanalyse ergab, dass die Odds Ratio (OR) für RHD, doppelten Klappenersatz und Pilzinfektion als Risikofaktoren des Schlaganfalls 7,26 (95%-KI: 1,23–42,68); 25,60 (95%-KI: 4,33–126,16) bzw. 20,58 (95%-KI: 2,13–198,82) betrug und statistisch signifikant war. Während der stationären Behandlung starben 8 Patienten, die Krankenhausmortalität lag bei 12,90%. Die OR für die Krankenhausmortalität bei gleichzeitigem Schlaganfall betrug 5,13 (95%-KI: 1,08–24,46; p = 0,028).

Schlussfolgerung

Ein Schlaganfall ist eine häufige Komplikation bei KPE und erhöht die Mortalität. Risikofaktoren für Patienten mit KPE und der Komplikation eines Schlaganfalls sind möglicherweise RHD, doppelter Klappenersatz und Pilzinfektionen.

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Change history

  • 28 May 2019

    <Emphasis Type="Bold">Erratum to:</Emphasis>

    <Emphasis Type="Bold">Herz 2019</Emphasis>

    <ExternalRef><RefSource>https://doi.org/10.1007/s00059-019-4809-4</RefSource><RefTarget Address="10.1007/s00059-019-4809-4" TargetType="DOI"/></ExternalRef>

    The original article has been corrected. The data given in Table 4 for patient No. 13 were wrong. Please find here the corrected Table.

    The authors and publisher apologize for this …

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Authors and Affiliations

  1. Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, NO 2 Anzhen Road, 100029, Beijing, China

    G.-F. Cao & L. Cao

  2. Center For Medical Device Evaluation, National Medical Products Administration, Beijing, China

    W. Liu

  3. Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China

    Y. Wang

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  1. G.-F. Cao
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  2. W. Liu
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  3. L. Cao
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  4. Y. Wang
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Correspondence to G.-F. Cao.

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Conflict of interest

G.-F. Cao, W Liu, L. Cao, and Y. Wang declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements.

Additional information

The original version of this article was revised. The data given in Table 4 for patient No. 13 were published wrong.

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Cao, GF., Liu, W., Cao, L. et al. Stroke in patients with prosthetic valve endocarditis. Herz 45 (Suppl 1), 72–77 (2020). https://doi.org/10.1007/s00059-019-4809-4

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