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(Stroke. 2009;40:3461.)
© 2009 American Heart Association, Inc.

Original Contributions

Cerebral Microbleeds Are Frequent in Infective Endocarditis

A Case-Control Study

Isabelle Klein, MD, PhD; Bernard Iung, MD; Julien Labreuche, BST; Agathe Hess, MD; Michel Wolff, MD; David Messika-Zeitoun, MD; Philippa Lavallée, MD; Jean-Pierre Laissy, MD, PhD; Catherine Leport, MD, PhD; Xavier Duval, MD, PhD the IMAGE Study Group

From AP-HP, Departments of Radiology (I.K., A.H., J.-P.L.), Cardiology (B.I., D.M.-Z.), Neurology (J.L., P.L.), Intensive Care (M.W.), and Infectious and Tropical Diseases (C.L., X.D.), Bichat University Hospital, Paris, France; AP-HP, Department of Intensive care, Bichat University Hospital, Paris, France; Inserm CIC 007 (X.D.), Centre d'Investigation Clinique; Inserm 738; Université Paris 7, UFR de Médecine, Paris, France; and AP-HP, Département d'Epidémiologie (X.D.), Biostatistique et Recherche Clinique Bichat University Hospital, Paris, France.

Correspondence to Isabelle Klein, MD, PhD, Department of Radiology, Bichat University Hospital, 46 rue Henri Huchard, 75018 Paris, France. E-mail isabelle.klein{at}bch.aphp.fr

Background and Purpose— Cerebral microbleeds (CMBs) have been described using MRI in patients with cardiovascular risk factors or prior stroke and could be an indicator of small vessel disease. CMBs have been reported in isolated cases of infective endocarditis (IE), but their frequency and the association of CMBs with IE have not yet been studied.

Methods— A case-control imaging study in a referral institutional tertiary care center was conducted. Systematic brain MRIs, including T2*-weighted sequences, were performed in 60 patients with IE within 7 days of hospital admission and in 120 age- and gender-matched control subjects without IE. Two neuroradiologists, who were blinded to patient characteristics, independently assessed the presence, location, and size of CMBs using a standardized form.

Results— The interobserver agreement level on the presence of CMBs was high with a coefficient range (95% CI) of 0.70 (0.42 to 0.98) for subcortical regions to 0.91 (0.82 to 0.99) for cortical areas. CMBs were more prevalent in patients with IE (57% [n=34]) than in control subjects (15% [n=18]; matched OR, 10.06; 95% CI, 3.88 to 26.07). Moreover, the OR of IE increased gradually with CMBs number with an OR of 6.12 (95% CI, 2.09 to 17.94) for one to 3 CMBs and of 20.12 (95% CI, 5.20 to 77.80) for >3 CMBs.

Conclusion— CMBs are highly frequent in patients with IE. The strong association found between IE and CMBs supports the need for further evaluation of CMBs as additional diagnostic criteria of IE.

Key Words: cerebral microbleeds • endocarditis • mycotic aneurysm • T2* MRI