Increased prevalence of potential right-to-left shunting in children with sickle cell anaemia and stroke
Increased prevalence of potential right-to-left shunting in children with sickle cell anaemia and stroke
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DOI：
10.1111/bjh.14391
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发表时间：
2017-01-01
影响因子：
6.5
通讯作者：
Hynan, Linda S.
中科院分区：
文献类型：
--
作者：
Dowling, Michael M.;Quinn, Charles T.;Hynan, Linda S.
通过心内或肺内右至左分流（RLS）的“矛盾”栓塞是卒中的一个确定原因。高凝状态和右心压力增加，两者都发生在镰状细胞性贫血（SCA），易发生矛盾栓塞。我们假设患有SCA和显性卒中（SCA +卒中）的儿童有潜在的RLS患病率增加。我们对147名患有SCA +卒中的儿童（年龄2-19岁）（平均年龄12.7±4.8岁，男性54.4%）和无SCA或卒中的对照组（n = 123，平均年龄12.1±4.9岁，男性53.3%）进行了对比经胸超声心动图检查。RLS定义为通过任何方法检测到的任何潜在的RLS，包括肺内分流。超声心动图被掩盖并集中裁决。SCA+卒中组的潜在RLS患病率明显高于对照组（45.6%比23.6%,P < 0.001）。SCA +卒中组潜在RLS的优势比为2.7（95%可信区间：1.6-4.6）。事后分析显示，SCA +卒中组肺内分流发生率较高（23.8%比5.7%,P < 0.001），但心内分流发生率不高（21.8%比18.7%,P = 0.533）。有潜在RLS的SCA患者在卒中发作时报告头痛的可能性大于没有RLS的SCA患者。肺内和心内分流可能是SCA卒中的一个被忽视的、独立的、潜在的可改变的危险因素。
'Paradoxical' embolization via intracardiac or intrapulmonary right-to-left shunts (RLS) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (SCA), predispose to paradoxical embolization. We hypothesized that children with SCA and overt stroke (SCA + stroke) have an increased prevalence of potential RLS. We performed contrasted transthoracic echocardiograms on 147 children (aged 2-19 years) with SCA + stroke) mean age 12.7 +/- 4.8 years, 54.4% male) and a control group without SCA or stroke (n = 123; mean age 12.1 +/- 4.9 years, 53.3% male). RLS was defined as any potential RLS detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential RLS was significantly higher in the SCA+stroke group than controls (45.6% vs. 23.6%, P < 0.001). The odds ratio for potential RLS in the SCA + stroke group was 2.7 (95% confidence interval: 1.6-4.6) vs controls. In post hoc analyses, the SCA + stroke group had a higher prevalence of intrapulmonary (23.8% vs. 5.7%, P < 0.001) but not intracardiac shunting (21.8% vs. 18.7%, P = 0.533). SCA patients with potential RLS were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in SCA.