Long-term evolution and functional impact of cerebral lesions detected by systematic brain magnetic resonance imaging in patients with infective endocarditis: the POST-IMAGE prospective cohort

Abstract

Background and purpose: Systematic brain magnetic resonance imaging (MRI) reveals lesions in almost all patients with infective endocarditis (IE), but their long-term evolution and clinical impact have not been investigated. We aimed to describe the evolution of cerebral lesions detected by systematic MRI during acute IE and to assess their clinical consequences during follow-up.

Methods: We conducted a single-center observational prospective study nested into the ECHO-IMAGE cohort, comparing systematic brain MRIs performed during a follow-up visit with those performed during the IE episode. We analyzed cerebral lesions evolution and their association with patients' functional disability, cognitive impairment, depression and quality of life.

Results: Among the 100 included patients who underwent the follow-up visit after a median of 37 [21-74] months after the initial episode of IE, MRI neurological lesions were found in 80% of cases at follow-up, as compared to 84% during the IE episode. Most of these lesions were stable or decreased over time, except for the number of cerebral microbleeds, which increased significantly. At follow-up, functional disability, cognitive impairment, and depression were observed in 4%, 14%, and 59% of cases, respectively. Quality of life remained significantly altered in 3 dimensions, as compared to a control general French population. No association was found between the presence of cerebral lesions, the severity of IE episode and outcomes.

Conclusion: Cerebral lesions on systematic MRI are frequent during IE, and their evolution is stable over time, with the exception of cerebral microbleeds. We observed no association between cerebral lesions and long-term clinical consequences of IE.

Keywords: Cerebral lesions; Functional outcomes; Infective endocarditis; Magnetic resonance imaging.