engleski

Neurologic complications of infective endocarditis in the elderly: results of the International Collaboration on Endocarditis Prospective Cohort Study

Septic embolic stroke (SES) is a major complication of infective endocarditis (IE), and its incidence was shown to be lower among elderly subjects. Since elderly IE may have peculiar clinical characteristics, in this study we aimed at evaluating risk factors and prognostic implications for SES according to age. Among 2759 consecutive patients enrolled in the International Collaboration on Endocarditis Prospective Cohort Study admitted between June 2000 and December 2006, there were 1056 elderly (age &#8805; 65 years) and 1703 younger subjects (< 65 year old). 458 (20.4%) experienced a SES. Elderly patients showed a significant trend for a lower incidence of stroke (14.68 vs 17.79% in the younger ; p=0.028). This difference was mostly due to lower rates of hemorrhagic strokes among elderly patients (1.9 vs 3.8% ; p=0.03), despite the fact that elderly patients were receiving significantly more frequently aspirin (25% vs 10%) or oral anticoagulants (23 vs 14%) (p<0.0001 for both comparisons). SES pathogenesis was embolic in 72% of elderly and 64% of younger patients, and hemorrhagic in 13.5 and 21.8%, respectively. These differences were paralleled by a lower rate of vascular/ immunologic phenomena, such as osler nodes, janeway lesions, hematuria, conjunctival or splinter hemorrhages and vascular embolic events (p<0.001 for all comparisons). As relates the site of infection, elderly patients showed a higher rate of mitral valve involvement, that was shown to increase independently the risk of SES. Echocardiographic and surgical findings showed lesser evidence of valve vegetations in elderly patients. Coherently, among the major indications for surgery, prior embolism or a large vegetation were significantly less common in elderly IE cases. Elderly patients with IE have a lower risk of SES and, in particular, of cerebral hemorrhage, despite higher frequency of anticoagulant/antiplatelet treatment and mitral valve involvement. Possible reasons for this finding are a reduced inflammatory and hemostatic function with reduced efficiency of vegetation formation.

IE; septic embolic stroke; cardiac surgery; outcome

nije evidentirano