Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study.

Abstract:

BACKGROUND:Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis. OBJECTIVE:To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults. DESIGN:Single-center prospective study between June 2005 and October 2008. (ClinicalTrials.gov registration number: NCT00144885) SETTING:Tertiary care university hospital in France. PATIENTS:130 patients with endocarditis. INTERVENTION:Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention. MEASUREMENTS:2 experts jointly established the endocarditis diagnostic classification (according to Duke-modified criteria) and therapeutic plans just before and after MRI and then compared them. RESULTS:Endocarditis was initially classified as definite in 77 patients and possible in 50 and was excluded in 3. Sixteen patients (12%) had acute neurologic symptoms. Cerebral lesions were detected by MRI in 106 patients (82% [95% CI, 75% to 89%]), including ischemic lesions in 68, microhemorrhages in 74, and silent aneurysms in 10. Solely on the basis of MRI results and excluding microhemorrhages, diagnostic classification of 17 of 53 (32%) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (3 patients). Endocarditis therapeutic plans were modified for 24 (18%) of the 130 patients, including surgical plan modifications for 18 (14%). Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28% [CI, 20% to 36%]). LIMITATION:Investigators did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs. CONCLUSION:Cerebral lesions were identified by MRI in many patients with endocarditis but no neurologic symptoms. The MRI findings affected both diagnostic classifications and clinical management plans. PRIMARY FUNDING SOURCE:French Ministry of Health.

journal_name

Ann Intern Med

authors

Duval X,Iung B,Klein I,Brochet E,Thabut G,Arnoult F,Lepage L,Laissy JP,Wolff M,Leport C,IMAGE (Resonance Magnetic Imaging at the Acute Phase of Endocarditis) Study Group.

doi

10.7326/0003-4819-152-8-201004200-00006

subject

Has Abstract

pub_date

2010-04-20 00:00:00

pages

497-504, W175

issue

8

eissn

0003-4819

issn

1539-3704

pii

152/8/497

journal_volume

152

pub_type

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