Clinical and Imaging Characteristics of Infective Endocarditis‐Associated Versus Atrial Fibrillation‐Associated Stroke

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Background Infective endocarditis (IE) is a major cause of cardioembolic stroke, leading to poor outcomes if not diagnosed appropriately. We compared clinical and imaging characteristics between IE‐associated stroke (IE‐stroke) and atrial fibrillation stroke presenting with fever. Methods Patients with embolic infarction diagnosed with IE based on transthoracic echocardiography were reviewed. Patients with atrial fibrillation‐stroke presenting with fever served as the comparator group. Clinical characteristics, imaging characteristics, and outcomes were compared. Lesion patterns were analyzed according to the number of lesions and vascular territories. Parenchymal hematoma, stroke recurrence, and mortality were also investigated. Results The study included 170 patients with IE‐stroke and 153 patients with atrial fibrillation stroke. Those with IE‐stroke demonstrated smaller lesions (21.6±19.3 mm versus 66.9±38.0 mm, P <0.001), a higher proportion with >10 lesions (44.7% versus 5.2%, P <0.001), and predominant bilateral anterior–posterior circulation involvement (54.1% versus 2.6%, P <0.001). Independent predictors of IE‐stroke included younger age (odds ratio [OR], 0.87 [95% CI, 0.82–0.92], P <0.001), smaller lesion size (OR, 0.94 95% CI, 0.92–0.97, P <0.001), and 3‐territory involvement (OR, 81.21 [95% CI, 16.20–407.00], P <0.001). Parenchymal hematoma rates were comparable (12.9% versus 11.1%, P =0.614). Ischemic lesion recurrence was higher in IE‐stroke (53.2% versus 18.1%; OR, 6.94 [95% CI, 3.41–14.12], P <0.001). Although unadjusted mortality rates did not differ, adjusted analysis showed higher odds of 3‐month mortality in IE‐stroke (OR, 3.82 [95% CI, 1.71–8.50], P =0.001). Conclusions IE‐stroke lesions were more numerous, smaller, and dispersed across multiple vascular territories with higher recurrence rates compared with atrial fibrillation stroke. Despite lesion size difference, parenchymal hematoma rates were similar. These characteristics may aid in distinguishing IE‐stroke in patients with embolic stroke and fever.

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