Evaluation of the Prognostic Impact of a Neuro-vascular Examination Associated With Cerebral MRI in the Acute Phase of Infectious Endocarditis

Study Overview
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Brief Summary
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Infectious endocarditis (IE) is a serious condition with an annual incidence of 3 to 10 per 100,000 people. Brain infarctions complicate approximately 20-40% of endocarditis. Brain MRI can detect the presence of recent ischemic lesions and asymptomatic microbleeds. Preoperative brain imaging is part of the recommended assessment in the management of IEs, but the type of imaging and sequences are not codified and the impact of cerebral and vascular imaging findings on the therapeutic decision remains uncertain. The level of evidence of the recommendations remains low, especially for complicated IEs of stroke. There is very little neurological clinical data on patients with IEs. Similarly, neurologists do not systematically participate in multidisciplinary meetings during the management of an IE. It therefore seems interesting to carry out a neurological cohort of this population and to evaluate what would be the contribution of vascular neurologists in the management of infectious endocarditis.

Official Title
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Prospective Pilot Study Evaluating the Prognostic Impact of a Neuro-vascular Examination Associated With Cerebral MRI in the Acute Phase of Infectious Endocarditis

Conditions
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Endocarditis, Stroke

Intervention / Treatment
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* Other: Neurological assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients Certain infectious endocarditis according to Dukes Criteria Signed informed consent Exclusion Criteria: Hospital admission due to neurovascular emergency MRI contraindications Pregnant or women of childbearing age who were not using contraception (oral diagnosis), Patient without health coverage, Patient under legal protection.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Neurological cohort<br>All patients included in the study wil have a neurological examination | Other: Neurological assessment<br>* No specific procedure is planned for the study other than the neurological examination by a neurologist of all patients. The patient will be taken care according to current recommendations. In addition, a study-specific, non-injected brain CT scan will be performed systematically in patients undergoing cardiac surgery to evaluate postoperative hemorrhagic transformation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medical care modification | Description of the medical care modification after neurological assessment, evaluated by the number of patients with modified medical care by the request for a new examination compared to the initially scheduled care. | at 3 months | 
| Medical care modification | Description of the medical care modification after neurological assessment, evaluated by the number of patients with modified medical care by the change of therapy compared to the initially scheduled care. | at 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The description of the preoperative neurological impairment | Description of preoperative neurological impairment assessed by NIHSS score | During initial hospitalization | 
| The description of the preoperative neurological impairment | Description of preoperative neurological impairment assessed by the presence of brain lesions on initial MRI | During initial hospitalization | 
| The description of the perioperative hemorrhagic risk | Description of the perioperative hemorrhagic risk evaluated by the rate of haemorrhagic transformation on the post-surgery control scanner | 24 to 96 hours post-surgery | 
| Prognosis assessment | Evaluation of prognosis by the rate of deaths and stroke | at 3 months | 
| Evaluation of functional prognosis | Evaluation of the functional prognosis measured by the mRS score | at 3 months | 
| Evaluation of depressive anxiety disorders | Evaluation of depressive anxiety disorders measured by the Hamilton Anxiety Depression scale | at 3 months | 
| Evaluation of the cognitive prognosis | Evaluation of the cognitive prognosis evaluated by the MOCA score | at 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neurological assessment, Medical care