Ischemic Stroke and TIA in a Cohort of Adults with Congenital Heart Disease: A Single Center Cross Sectional Study (P6-5.004)

Abstract

<h3>Objective:</h3> To identify risk factors for ischemic stroke and TIA in adults with congenital heart disease (ACHD). <h3>Background:</h3> ACHD are at high risk for ischemic stroke, but specific risk factors within this population are not well characterized. <h3>Design/Methods:</h3> 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. <h3>Results:</h3> 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. <h3>Conclusions:</h3> 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. <b>Disclosure:</b> Dr. Mammadli has nothing to disclose. Dr. Kochav has nothing to disclose. Mrs. Argenio has nothing to disclose. Mrs. Sariyeva has nothing to disclose. Dr. Bilski has nothing to disclose. Dr. Ibeh has nothing to disclose. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edwards Scientific. Dr. Willey has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for RECARDIO. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Uptodate. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Review chapter author, MKSAP 16-20 with American College of Physicians. Dr. Rosenbaum has stock in Amgen. Dr. Rosenbaum has stock in Ascendis Pharma. Dr. Rosenbaum has stock in Regeneron. Dr. Rosenbaum has stock in CRISPR Therapeutics. Dr. Rosenbaum has stock in HCA Healthcare. The institution of Dr. Rosenbaum has received research support from Janssen Research Pharma. Matthew Lewis has nothing to disclose. Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Argionis and Associates LLC. The institution of Dr. Miller has received research support from National Institutes of Health.