RISK OF STROKE IN ADULTS WITH CYANOTIC CONGENITAL HEART-DISEASE

被引:108
作者
PERLOFF, JK
MARELLI, AJ
MINER, PD
机构
[1] UNIV CALIF LOS ANGELES,CTR ADULT CONGENITAL HEART DIS,LOS ANGELES,CA 90024
[2] UNIV CALIF LOS ANGELES,DEPT PEDIAT,DIV CARDIOL,LOS ANGELES,CA 90024
关键词
CONGENITAL HEART DISEASE; STROKE; BLOOD CELLS; HEMODYNAMICS;
D O I
10.1161/01.CIR.87.6.1954
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Adults with cyanotic congenital heart disease and elevated hematocrit levels are often phlebotomized because of an assumed risk of cerebral arterial thrombotic stroke. Whether a relation exists between hematocrit level, symptomatic erythrocytosis (hyperviscosity), and stroke remains to be established in this patient population. Methods and Results. Accordingly, 112 cyanotic patients 19-74 years old (mean, 36 +/- 11.7 years) in the UCLA Adult Congenital Heart Disease Center Registry were selected for study by virtue of continuous observation for 1-12 years (total, 748 patient-years). Patients with independent risk factors for embolic or vasospastic stroke were excluded. The study patients were then divided into two groups: 1) compensated erythrocytosis (stable hematocrit levels of 46.0-72.7% [mean, 57.5 +/- 7.2%], iron replete, absent or mild hyperviscosity symptoms), and 2) decompensated erythrocytosis (unstable rising hematocrit levels of 61.5-75.0% [mean, 69.5 +/- 10.6%], iron deficiency, marked-to-severe hyperviscosity symptoms). No patient with either compensated or decompensated erythrocytosis, irrespective of hematocrit level, iron stores, or the presence, degree, or recurrence of cerebral hyperviscosity symptoms, progressed to clinical evidence of a completed stroke (cerebral arterial thrombosis with brain infarction). Conclusions. Because a risk of stroke caused by cerebral arterial thrombosis was not demonstrated, because the circulatory effects of phlebotomy are transient, and because of the untoward sequelae of phlebotomy-induced iron deficiency, we recommend phlebotomy for the temporary relief of significant, intrusive hyperviscosity symptoms but not for the hematocrit level per se. According to our data, phlebotomy is not warranted to reduce an assumed risk of stroke because that risk did not materialize.
引用
收藏
页码:1954 / 1959
页数:6
相关论文
共 42 条
[1]  
AMITAI Y, 1984, ISRAEL J MED SCI, V20, P1143
[2]  
ANDERSON RH, 1987, PAEDIATRIC CARDIOLOG, P775
[3]  
BERK PD, 1986, SEMIN HEMATOL, V23, P132
[4]  
BERK PD, 1992, CECIL TXB MED, V19, P920
[5]   SYSTEMIC OXYGEN-TRANSPORT IN PATIENTS WITH CONGENITAL HEART-DISEASE [J].
BERMAN, W ;
WOOD, SC ;
YABEK, SM ;
DILLON, T ;
FRIPP, RR ;
BURSTEIN, R .
CIRCULATION, 1987, 75 (02) :360-368
[6]  
BERTHRONG M, 1951, B JOHNS HOPKINS HOSP, V89, P384
[7]   CEREBRAL VASCULAR ACCIDENTS IN CYANOTIC CONGENITAL HEART-DISEASE [J].
COTTRILL, CM ;
KAPLAN, S .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1973, 125 (04) :484-487
[8]   HEMATOCRIT, VISCOSITY AND CEREBRAL BLOOD-FLOW [J].
FRIEDLAND, RP ;
GRANT, S .
AMERICAN HEART JOURNAL, 1979, 97 (03) :404-405
[9]  
FRUCHTMAN SM, 1991, CONNS CURRENT THERAP, P386
[10]   PRIMARY PULMONARY-HYPERTENSION - NATURAL-HISTORY AND THE IMPORTANCE OF THROMBOSIS [J].
FUSTER, V ;
STEELE, PM ;
EDWARDS, WD ;
GERSH, BJ ;
MCGOON, MD ;
FRYE, RL .
CIRCULATION, 1984, 70 (04) :580-587