Cerebral Micro Emboli Signal Detection in Endocarditis. A prospective follow-up study

Although endocarditis is relatively rare (incidence between the
1.5-11.6/100,000 person years), the disease is still a great burden to public
health endocarditis as a disease with a high mortality and morbidity. The
mortality in an infective endocarditis is on average around the 15-20% [1.2],
rising to 80% at the presence of Staphylococcus Aureus/heart
failure/annulusabces.
Complications of endocarditis could be manifest locally in the heart itself
(abscesses/aneurysms/fistulas), but also peripheral including septic
embolization to other organs. Embolic complications, such as developing a
cerebral infarction, is associated with a greatly increased risk of mortality.
Ultrasound of the heart is not only important for the diagnosis endocarditis,
but also an important part of the risk determination to getting complications.
The risk stratification with echocardiography is not sufficiently reliable to
predict the risk of systematic and cerebral embolic complications.
Technology Doppler (TCD-Doppler) can detect micro-emboli signals (MES). This
method is shown in several studies to be effective in patients with acute
cerebral infarction, symptomatic carotid stenosis and post-operative after a
carotisendarteriëctomy in predicting high-risk patients developing a stroke
recurrence. TCD-Doppler technology seems to be of great value in identifying a
subpopulation that, despite antibiotic therapy, is at high risk of embolic
complications.

The evaluate the value of the TCD in a selected patients group with a
left-tailed endocarditis -treated in first case with antibiotic - to predict
the chance of a CVA. The primary goal is to develop a prediction model.

This will be a prospective, observational study with micro embolic signal
detection in patients with recently a left-tailed endocarditis diagnosis and
the treatment will be primary antibiotic.
Micro embolic signal detection with TCDx will unilaterally take place within
3-5 days after diagnosis. At inclusion and after 12 weeks is an MRI with
certain sequences (the so called diffusion weighted imaging [DWI] and the
susceptibility weighted imaging [SWI]), this makes it possible to recent
subclinical ischemic CVA's (with DWI sequences) or micro hemorrhages (with SWI
sequences). MRI will also be done with a Flair and T2 setting to not recent
ischemia to quantify. Patients who have to undergo surgery for the
endocarditis, will receive their second MRI <24hours prior to the surgery.

This study will be provide information if TCD embolism detection can be used in
risk stratification of the occurrence of a embolic CVA. There are no advantages
or disadvantages for the patient. TCD research is an easy-to-use non-invasive
analysis of the cerebral blood stream by ultra sound.