• Erwan Salaun, Anissa Touil, Sandrine Hubert, Jean-Paul Casalta, Frédérique Gouriet, Emmanuelle Robinet-Borgomano, Emilie Doche, Nadia Laksiri, Caroline Rey, Cécile Lavoute, Sébastien Renard, Hervé Brunel, Anne-Claire Casalta, Julie Pradier, Jean-François Avierinos, Hubert Lepidi, Laurence Camoin-Jau, Alberto Riberi, Didier Raoult, and Gilbert Habib.
• Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France. Electronic address: salaun.er@gmail.com.
• Arch Cardiovasc Dis. 2018 Dec 1; 111 (12): 712-721.

BackgroundAlthough intracranial cerebral haemorrhage (ICH) complicating infective endocarditis (IE) is a critical clinical issue, its characteristics, impact, and prognosis remain poorly known.AimsTo assess the incidence, mechanisms, risk factors and prognosis of ICH complicating left-sided IE.MethodsIn this single-centre study, 963 patients with possible or definite left-sided IE were included from January 2000 to December 2015.ResultsSixty-eight (7%) patients had an ICH (mean age 57±13 years; 75% male). ICH was classified into three groups according to mechanism: ruptured mycotic aneurysm (n=22; 32%); haemorrhage after ischaemic stroke (n=27; 40%); and undetermined aetiology (n=19; 28%). Five variables were independently associated with ICH: platelet count<150×109/L (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.01-5.4; P=0.049); severe valve regurgitation (OR 3.2, 95% CI 1.3-7.6; P=0.008); ischaemic stroke (OR 4.2, 95% CI 1.9-9.4; P<0.001); other symptomatic systemic embolism (OR 14.1, 95% CI 5.1-38.9; P<0.001); and presence of mycotic aneurysm (OR 100.2, 95% CI 29.2-343.7; P<0.001). Overall, 237 (24.6%) patients died within 2.3 (0.7-10.4) months of follow-up. ICH was not associated with increased mortality (P not significant). However, the 1-year mortality rate differed according to ICH mechanism: 14%, 15% and 45% in patients with ruptured mycotic aneurysm, haemorrhage after ischaemic stroke and undetermined aetiology, respectively (P=0.03). In patients with an ICH, mortality was higher in non-operated versus operated patients when cardiac surgery was indicated (P=0.005). No operated patient had neurological deterioration.ConclusionsICH is a common complication of left-sided IE. The impact on prognosis is dependent on mechanism (haemorrhage of undetermined aetiology). We observed a higher mortality rate in patients who had conservative treatment when cardiac surgery was indicated compared with in those who underwent cardiac surgery.Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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