Murai Ryosuke, Kaji Shuichiro, Kitai Takeshi, Kim Kitae, Ota Mitsuhiko, Koyama Tadaaki, Furukawa Yutaka
Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Semin Thorac Cardiovasc Surg. 2019 Spring;31(1):51-58. doi: 10.1053/j.semtcvs.2018.09.020. Epub 2018 Oct 2.
We assessed the clinical features of cerebral microbleeds (CMBs) and their association with clinical outcomes in active infective endocarditis patients. From January 2009 to June 2015, 132 active IE patients diagnosed per the modified Duke's criteria were retrospectively reviewed. Brain magnetic resonance imaging was performed in 102 patients, and 74 patients whose image data were available to assess CMBs were enrolled. CMBs were defined as hypointense lesion <10 mm in diameter, seen on T2* or susceptibility-weighted imaging. Forty patients had CMB and 34 did not. Patients with CMB were older, and the proportion of prior antiplatelet therapy, staphylococcal infection, and prosthetic valve endocarditis were higher than in patients without CMB. Surgery was performed in 25 (63%) patients with CMB and 24 (71%) patients without CMB. There was no significant difference in the de novo stroke incidence postoperatively (16% vs 17%, P = 0.95). Although all-cause mortality rate tended to be higher in patients with CMB, there were no significant differences in the in-hospital mortality rate and estimated 1-year major adverse event rate between the 2 groups (13% vs 12%, P = 0.92; 20% vs 19%, P = 0.35). Cox regression analysis adjusting age and operative risk did not show that CMB was a significant risk factor for all-cause death and major adverse event. Patients with CMB were older than those without, and microbleeds were associated with antiplatelet therapy, staphylococcal infection, and prosthetic valve endocarditis. However, the mid-term clinical outcomes of patients with CMB and those without were comparable.
我们评估了活动性感染性心内膜炎患者脑微出血（CMB）的临床特征及其与临床结局的关联。2009年1月至2015年6月，对132例根据改良Duke标准确诊的活动性感染性心内膜炎患者进行了回顾性研究。102例患者接受了脑磁共振成像检查，其中74例患者的图像数据可用于评估CMB，纳入研究。CMB定义为在T2*或磁敏感加权成像上可见的直径<10 mm的低信号病变。40例患者有CMB，34例没有。有CMB的患者年龄较大，既往抗血小板治疗、葡萄球菌感染和人工瓣膜心内膜炎的比例高于无CMB的患者。25例（63%）有CMB的患者和24例（71%）无CMB的患者接受了手术。术后新发卒中发生率无显著差异（16%对17%，P = 0.95）。虽然有CMB的患者全因死亡率有升高趋势，但两组的住院死亡率和估计的1年主要不良事件发生率无显著差异（13%对12%，P = 0.92；20%对19%，P = 0.35）。调整年龄和手术风险的Cox回归分析未显示CMB是全因死亡和主要不良事件的显著危险因素。有CMB的患者比没有的患者年龄大，微出血与抗血小板治疗、葡萄球菌感染和人工瓣膜心内膜炎有关。然而，有CMB和无CMB患者的中期临床结局相当。
