Ischemic Stroke and TIA in a Cohort of Adults with Congenital Heart Disease: A Single Center Cross Sectional Study
Gular Mammadli1, Jonathan Kochav2, Melissa Argenio2, Mehriban Sariyeva3, Amanda Bilski3, Chinwe Ibeh3, Joshua Willey3, Marlon Rosenbaum2, Matthew Lewis2, Eliza Miller3
1Neurology, Westchester Medical Center/NYMC, 2Cardiology, 3Neurology, Columbia University Irving Medical Center
Objective:

To identify risk factors for ischemic stroke and TIA in adults with congenital heart disease (ACHD).

Background:
ACHD are at high risk for ischemic stroke, but specific risk factors within this population are not well characterized. 
Design/Methods:
We reviewed medical records of patients evaluated in an ACHD clinic who underwent brain MRI for any reason between 8/1/1995 and 3/1/2022.  We excluded patients with intracerebral, subarachnoid, or subdural hemorrhage or cerebral venous thrombosis. We collected phenotypic data including cardiac diagnoses, comorbidities, and medications. We compared characteristics in patients with and without ischemic stroke and TIA (IS/TIA) in univariable analysis.
Results:

Among 5740 available patient records, we identified 156 patients (median age 34 years; 61% White, 10% Black, 4% Asian, 23% Other/unknown) who underwent brain MRI, of whom 40 (26%) had IS/TIA (28 with IS, 12 with TIA). Anatomical subtypes included single ventricle/Eisenmenger’s (12%), mechanical valve (4%), right-sided heart disease or conotruncal abnormality (56%) and left sided heart disease (28%). There were no significant differences in age, sex, or race/ethnicity between those with and without IS/TIA. Proportions of hypertension and migraine also did not differ between groups. Individuals with IS/TIA had lower oxygen saturation (94% vs 97%, p=0.01), higher proportion of moderate or greater ventricular dysfunction (p=0.04), higher proportion of supraventricular tachycardia (0.04), and higher proportion of NYHA class ≥ 2 (0.004). The distribution of cardiac anatomical subtypes did not differ significantly between those with and without IS/TIA.  

Conclusions:

Among patients with ACHD who underwent brain MRI, IS/TIA was associated with cyanosis, ventricular dysfunction, supraventricular tachycardia, and lower functional class, but not anatomic subtype. Future studies are required to define optimum stroke prevention protocols in this complex population. 

 

10.1212/WNL.0000000000202182