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Abstract Details

Injection Drug Use and Right-sided Endocarditis - Are We Missing the Strokes?
Infectious Disease
S31 - Infectious Disease: Stroke and Infectious Diseases (4:00 PM-4:08 PM)
001

To describe a series of patients with tricuspid valvular infective endocarditis (TVIE) who developed ischemic stroke within a larger registry of endocarditis patients at a single institution.
Injection drug use (IDU) is an epidemic in United States and frequently a source of TVIE. To date there has not been a study associating ischemic strokes specifically with TVIE. The most commonly thought of mechanism for this process is embolization via intracardiac shunts. The lack of robust data on this issue is a barrier when deciding the timing of valve replacement surgery.

We retrospectively reviewed all patients in the Boston Medical Center Endocarditis Inpatient Registry from November 2017 to March 2020 and included patients if they had positive blood cultures, tricuspid valve vegetations confirmed on echocardiography, as well as neuroimaging demonstrating evidence of ischemic stroke. Functional outcome was based on modified Rankin Scale scores at discharge and at follow-up. The study protocol was IRB approved.
We screened 141 patients out of which 65 patients (46%) had TVIE. Thirty-one of the patients with TVIE (49%) underwent neuroimaging during the course of their hospitalization. Nine patients (28%) were identified as having TVIE complicated by ischemic strokes, of which only 3 had intracardiac shunts. Compared to purely left-sided valvular endocarditis, only 49% of patients received neuroimaging (82% left-sided). Of the patients with purely left-sided endocarditis, 62% had ischemic strokes. The rates of IDU amongst patients with left and right sided endocarditis were high (89% vs 61%). Of the TVIE cohort 2 patients died and the mRS for the survivors ranged from 0-4.

Cerebral infarction associated with TVIE was frequently identified when imaging was performed. The mechanisms of stroke in TVIE are heterogeneous. Neurologic examination and routine imaging in IDU-associated TVIE are essential for safe decision making regarding anticoagulation and valvular surgery. 
Authors/Disclosures
Karan Hingorani, MD, PhD (Boston Medical Center)
PRESENTER 		Dr. Hingorani has nothing to disclose.
Erin Barnes, MD (Albany Medical Center) Dr. Barnes has nothing to disclose.
Thiago S. Carneiro, MD Dr. Carneiro has nothing to disclose.
Pria Anand, MD (Boston University School of Medicine) Dr. Anand has nothing to disclose.
Charlene J. Ong, MD (Boston University) Dr. Ong has nothing to disclose.
David Y. Chung, MD (Massachusetts General Hospital) Dr. Chung has received research support from NIH/NINDS. Dr. Chung has received research support from The Aneurysm and AVM Foundation.
Ali Daneshmand, MD (Boston University School of Medicine) Dr. Daneshmand has nothing to disclose.
Kushak Suchdev, MD (Boston School of Medicine, Neurology) Dr. Suchdev has nothing to disclose.
Courtney Takahashi, MD, FAAN (John Muir Medical Center) Dr. Takahashi has received personal compensation in the range of $0-$499 for serving as a Consultant for Pfizer . Dr. Takahashi has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Insight Neuro LLC . Dr. Takahashi has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Keches Law Group. Dr. Takahashi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Brain IDX . Dr. Takahashi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for McGowan Law. Dr. Takahashi has received personal compensation in the range of $500-$4,999 for serving as a Employee, Founder with Tora Connections. Dr. Takahashi has a non-compensated relationship as a Committee Member with 好色先生 that is relevant to AAN interests or activities.
David M. Greer, MD, FAAN (Boston University School of Medicine) Dr. Greer 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 Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. The institution of Dr. Greer has received research support from Becton, Dickinson and Company. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care.
Julie G. Shulman, MD (Boston Medical Center) Dr. Shulman has received research support from the BU Spivack Neuroscience Pilot Award.
Hugo Javier Aparicio, MD, MPH (Boston University) Dr. Aparicio has received research support from 好色先生. Dr. Aparicio has received research support from Alzheimer's Association. Dr. Aparicio has received research support from National Institutes of Health. Dr. Aparicio has received personal compensation in the range of $10,000-$49,999 for serving as a expert panelist for the Memory & Healthy Aging Program with Cedars-Sinai.
Thanh Nguyen, MD Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vesalio. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avania. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Nguyen has received research support from Boston Medical Center. The institution of Dr. Nguyen has received research support from Society of Vascular and Interventional Neurology.
Jose R. Romero, MD (Boston University School of Medicine - Boston Medical Center) The institution of Dr. Romero has received research support from NIH/NIA.
Mohamad Abdalkader (Boston Medical Center Deptartment Of Radiology) Mohamad Abdalkader has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Anna Marisa Cervantes-Arslanian, MD, FAAN (BU Dept of Neurology) Dr. Cervantes-Arslanian has nothing to disclose.