Abstract Details

Title Marantic Endocarditis (ME) Markedly Reduces Survival in Cancer Patients with Ischemic Stroke

Topic Neuro-oncology

Presentation(s) P07 - (-)

Poster/Presentation
Number 002

Objective

Background BACKGROUND: The incidence and outcome of ME in cancer patients is poorly defined.

Design/Methods DESIGN/METHODS: We conducted a retrospective cohort study of consecutive inpatients with active cancer diagnosed with MRI-proven acute ischemic stroke at Memorial Sloan-Kettering from 2006-2009. Two independent reviewers classified stroke etiologies into prespecified categories, with differences adjudicated by consensus. We defined confirmed ME as echocardiographic or pathologic evidence of cardiac valve vegetation in the absence of positive blood cultures, and suspected ME as an undetermined stroke mechanism with an embolic-appearing radiographic infarct pattern. We compared the survival of patients with confirmed or suspected ME to those with strokes from all other causes using Kaplan-Meier statistics and the log-rank test. Cox proportional hazard analysis was performed to assess ME as a predictor of mortality independent of age, discharge modified Rankin Scale (mRS) score, and presence of metastases.

Results RESULTS: Of 213 study patients, 67 (31%) had confirmed (n=9) or suspected (n=58) ME, while large artery atherosclerosis (23%) and atrial fibrillation (18%) were common stroke mechanisms in the non-ME group. Demographics and cancer type were comparable between groups--gastrointestinal and lung accounted for 37% and 34% of primary cancers in the ME group and 22% and 28% in the non-ME group. Patients with ME more commonly had adenocarcinoma histology (75% vs. 53%), metastases (84% vs. 67%), and unfavorable discharge mRS (67% vs. 50%). Survival was significantly lower in patients with ME compared to those without ME (53% vs. 82% at 30 days and 28% vs. 61% at 90 days; p-value <0.0001). ME remained independently associated with mortality in multivariate analysis (HR, 2.2; 95% CI, 1.6-3.0).

Conclusions CONCLUSIONS: Strokes due to confirmed or suspected ME are associated with markedly reduced survival, independent of cancer extent and neurological disability.

Authors/Disclosures
Samuel Singer, MD PRESENTER	Dr. Singer has nothing to disclose.
Jacqueline B. Stone, MD, FAAN (Memorial Sloan-Kettering Cancer Center)	Dr. Stone has nothing to disclose.
Alexander Merkler, MD	Dr. Merkler has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurohospitalist. Dr. Merkler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for n/a.
Natalie T. Cheng, MD (Weill Cornell Medicine)	No disclosure on file
Liana Apostolova, MD, FAAN (Indiana University School of Medicine)	Dr. Apostolova has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NIH. Dr. Apostolova has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Apostolova has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Apostolova has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for siemens. Dr. Apostolova has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Apostolova has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam. Dr. Apostolova has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Alzheimer Association. The institution of Dr. Apostolova has received research support from Roche Diagnostics. The institution of Dr. Apostolova has received research support from NIA. The institution of Dr. Apostolova has received research support from Alzheimer Association. The institution of Dr. Apostolova has received research support from AVID radiopharmaceuticals. The institution of Dr. Apostolova has received research support from Life Molecular Imaging. Dr. Apostolova has a non-compensated relationship as a advisor with FDA that is relevant to AAN interests or activities.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Lisa M. DeAngelis, MD, FAAN	Dr. DeAngelis has received publishing royalties from a publication relating to health care.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MindRhythm Inc. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for multiple medicolegal firms.

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