Prevalence of cerebral and pulmonary thrombosis in patients with cyanotic congenital heart disease

TY - JOUR

T1 - Prevalence of cerebral and pulmonary thrombosis in patients with cyanotic congenital heart disease

AU - Jensen, A S

AU - Idorn, L

AU - Thomsen, C

AU - Recke, P. von der

AU - Mortensen, J

AU - Sørensen, K E

AU - Thilén, U

AU - Nagy, E

AU - Kofoed, K F

AU - Ostrowski, S R

AU - Søndergaard, L

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background: Patients with cyanotic congenital heart disease (CCHD) have a high prevalence of thrombosis, the most frequently described locations being the cerebral and pulmonary vessels. The reported prevalence of both cerebral infarction and pulmonary thrombosis has been highly variable. The aim of this study was to examine the prevalence of both cerebral and pulmonary thrombosis in CCHD according to medical history and imaging. In addition, the role of known erythrocytosis and haemostatic abnormalities as risk factors was evaluated. Methods and results: A cross-sectional descriptive study examining 98 stable adult patients with CCHD with a medical questionnaire, blood samples, MRI of the cerebrum (n=72), multidetector CT imaging (MDCT) of the thorax (n=76) and pulmonary scintigraphy (ventilation/perfusion/single-photon emission computerised tomography/CT) (n=66). The prevalence of cerebral infarction and pulmonary thrombosis according to imaging were 47% and 31%, respectively. Comparing the findings with previous medical history revealed a large under-reporting of thrombosis with only 22% of the patients having a clinical history of stroke and 25% of pulmonary thrombosis. There was no association between the degree of erythrocytosis or haemostatic abnormalities and the prevalence of thrombosis. Conclusions: Patients with CCHD have a prevalence of both cerebral and pulmonary thrombosis of around 30%-40%, which is much higher than that reported previously. Furthermore, there is a large discrepancy between clinical history and imaging findings, suggesting a high prevalence of silent thrombotic events. Neither erythrocytosis nor haemostatic abnormalities were associated with the prevalence of thrombosis in patients with CCHD.

AB - Background: Patients with cyanotic congenital heart disease (CCHD) have a high prevalence of thrombosis, the most frequently described locations being the cerebral and pulmonary vessels. The reported prevalence of both cerebral infarction and pulmonary thrombosis has been highly variable. The aim of this study was to examine the prevalence of both cerebral and pulmonary thrombosis in CCHD according to medical history and imaging. In addition, the role of known erythrocytosis and haemostatic abnormalities as risk factors was evaluated. Methods and results: A cross-sectional descriptive study examining 98 stable adult patients with CCHD with a medical questionnaire, blood samples, MRI of the cerebrum (n=72), multidetector CT imaging (MDCT) of the thorax (n=76) and pulmonary scintigraphy (ventilation/perfusion/single-photon emission computerised tomography/CT) (n=66). The prevalence of cerebral infarction and pulmonary thrombosis according to imaging were 47% and 31%, respectively. Comparing the findings with previous medical history revealed a large under-reporting of thrombosis with only 22% of the patients having a clinical history of stroke and 25% of pulmonary thrombosis. There was no association between the degree of erythrocytosis or haemostatic abnormalities and the prevalence of thrombosis. Conclusions: Patients with CCHD have a prevalence of both cerebral and pulmonary thrombosis of around 30%-40%, which is much higher than that reported previously. Furthermore, there is a large discrepancy between clinical history and imaging findings, suggesting a high prevalence of silent thrombotic events. Neither erythrocytosis nor haemostatic abnormalities were associated with the prevalence of thrombosis in patients with CCHD.

KW - Adult

KW - Cross-Sectional Studies

KW - Cyanosis

KW - Denmark

KW - Female

KW - Heart Defects, Congenital

KW - Humans

KW - Intracranial Thrombosis

KW - Lung

KW - Magnetic Resonance Imaging

KW - Male

KW - Medical Records

KW - Middle Aged

KW - Multidetector Computed Tomography

KW - Perfusion Imaging

KW - Predictive Value of Tests

KW - Prevalence

KW - Risk Factors

KW - Surveys and Questionnaires

KW - Thrombosis

KW - Tomography, Emission-Computed, Single-Photon

U2 - 10.1136/heartjnl-2015-307657

DO - 10.1136/heartjnl-2015-307657

M3 - Journal article

C2 - 26048878

SN - 1355-6037

VL - 101

SP - 1540

EP - 1546

JO - Heart

JF - Heart

IS - 19

ER -