Prevalence and prognostic significance of intracranial lesions assessed with MRI in infective endocarditis patients: Data from the Vesuve study - 27/10/26

Doi : 10.1016/j.neurol.2026.09.009

P. Clottes ^a,^b,^{^{1
Authors share the first authorship.},}⁎ , J. Fontaine ^a,^{^{1
Authors share the first authorship.}}, M. Hermier ^c, O.F. Eker ^c, T.-H. Cho ^a,^b, L. Mechtouff ^a,^b, N. Nighoghossian ^a,^b, F. Delahaye ^d, H. Thibault ^d, L. Derex ^a, E. Ong ^a,^b

^a Department of Stroke, Pierre Wertheimer neurological hospital, Hospices Civils de Lyon, Lyon, France

^b CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France

^c Department of Neuroradiology, Pierre Wertheimer neurological hospital, Hospices Civils de Lyon, Lyon, France

^d Department of Cardiology, Louis Pradel cardiovascular hospital, Hospices Civils de Lyon, Lyon, France

^⁎ Corresponding author .

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 27 October 2026

Highlights

•	Cerebral lesions were found on brain MRI in more than three-quarters of patients who had infective endocarditis.
•	The most prevalent lesions were cerebral microbleeds in 62.5% of patients and acute ischemic stroke in 60.4% of patients.
•	Acute ischemic stroke and subarachnoid hemorrhage were independently linked to mortality in infective endocarditis patients.

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Abstract

Background

Infective endocarditis (IE) is a life-threatening disease. Magnetic resonance imaging (MRI) is efficient to detect cerebral IE related lesions, which are known to worsen prognosis. Systematic use of MRI remains controversial due to insufficient scientific evidence. This work was aimed at clarifying the prognostic value of this imaging method in the context of IE.

Methods

The VESUVE study is a retrospective registry of patients with definite IE according to the modified Duke criteria, who had a brain MRI and were hospitalized between the 1st of November 2015 and the 15th of February 2019 in a Lyon University Hospital. All MRI were analyzed by the same senior neuroradiologist. Prognosis was evaluated by the mortality rate at 6 months.

Results

Among 212 patients, 162 were considered to have an abnormal MRI (76.4%). Acute ischemic stroke (AIS) was present in 125 patients (60.4%), intracranial hemorrhage in 8 patients (3.8%), hemorrhagic transformation in 41 patients (19.5%), subarachnoid hemorrhage (SAH) in 26 patients (12.4%), cerebral microbleed in 130 patients (62.5%), intracranial mycotic aneurysm in 10 patients (5.1%), sulcal microaneurysm in 45 patients (23.6%) and abscess in 3 patients (1.5%). Mortality rate at 6 months was 19% (37 patients deceased). AIS (26.9% mortality, 31 patients deceased, OR 5.11) and SAH (44% mortality, 11 patients deceased, OR 4.32) were linked to mortality.

Conclusion

The presence of AIS or SAH on brain MRI is independently linked to mortality in IE patients. This strengthens the prognostic value of MRI in the assessment of IE.

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Keywords : Stroke, Infectious endocarditis, MRI, Intracranial hemorrhage, Microbleed