Hoffman James L, Mack Gordon K, Minich L LuAnn, Benedict Susan L, Heywood Mason, Stoddard Gregory J, Saarel Elizabeth V
Department of Pediatrics, Divisions of Pediatric Cardiology, University of Utah, Salt Lake City, Utah 84113, USA.
Congenit Heart Dis. 2011 May-Jun;6(3):211-8. doi: 10.1111/j.1747-0803.2011.00510.x. Epub 2011 Mar 31.
Over the past three decades, significant advances in treatment have improved the mortality of children with cardiac disease. The effect of these advances on the prevalence of arterial ischemic stroke (AIS) is unknown. We describe AIS in children with cardiac disease in the modern era.
The prospectively enrolled Intermountain Pediatric Stroke Database (including Utah, Wyoming, Idaho, and Nevada) was queried for all patients less than 18 years old with new-onset AIS between January 1, 2003 and August 31, 2009. Medical records of patients with AIS and cardiac disease were reviewed for cardiac diagnosis, age at AIS, anticoagulant therapy, diuretics, hematocrit, bolus fluids, and ongoing morbidity. Data were analyzed using chi-square test and a mixed-effects Poisson regression growth curve model.
AIS incidence in our catchment area was 0.01% (10.7/100,000; N = 97). The incidence of AIS in patients with cardiac disease was higher compared with AIS in the total population (incidence 0.13% [132/100,000], odds ratio [OR] 16.1, 95% confidence interval [CI; 9.7--25.9], P < 0.001). Of the 97 patients with AIS, 24 had cardiac disease (25%). The most common cardiac diagnosis was single ventricle (SV; 8/24, 33%). The incidence of AIS in patients with SV cardiac disease was higher compared with those with other cardiac diagnoses (incidence 1.38% [1380/100,000], OR 15.3, 95% CI [5.7--38.2], P < 0.001). Modeling the prevalence estimates reported since 1978, the prevalence of cardiac disease in AIS patients has remained unchanged across time (prevalence increase per each additional year, 0.5%, 95% CI [--2.1%, 3.1%], P = 0.71).
Children with cardiac disease (particularly those with SV) have increased risk for AIS. The prevalence is unchanged from reports over previous decades. AIS occurred in SV patients despite compliance with current anticoagulation recommendations. Future efforts should focus on best practices to prevent AIS in cardiac patients.
在过去三十年中，治疗方面的重大进展提高了心脏病患儿的生存率。这些进展对动脉缺血性卒中（AIS）患病率的影响尚不清楚。我们描述了现代患有心脏病的儿童中的AIS情况。
对前瞻性纳入的山间儿科卒中数据库（包括犹他州、怀俄明州、爱达荷州和内华达州）中2003年1月1日至2009年8月31日期间所有18岁以下新发AIS患者进行查询。对患有AIS和心脏病的患者的病历进行回顾，以了解心脏诊断、AIS发生时的年龄、抗凝治疗、利尿剂、血细胞比容、静脉推注液体以及持续的发病率。使用卡方检验和混合效应泊松回归增长曲线模型对数据进行分析。
我们研究区域内AIS的发病率为0.01%（10.7/100,000；N = 97）。患有心脏病的患者中AIS的发病率高于总体人群中的AIS发病率（发病率0.13% [132/100,000]，优势比[OR] 16.1，95%置信区间[CI；9.7 - 25.9]，P < 0.001）。在97例AIS患者中，24例患有心脏病（25%）。最常见的心脏诊断是单心室（SV；8/24，33%）。患有SV心脏病的患者中AIS的发病率高于其他心脏诊断的患者（发病率1.38% [1380/100,000]，OR 15.3，95% CI [5.7 - 38.2]，P < 0.001）。根据自1978年以来报告的患病率估计值进行建模，AIS患者中心脏病的患病率随时间保持不变（每年患病率增加0.5%，95% CI [ - 2.1%，3.1%]，P = 0.71）。
患有心脏病的儿童（特别是那些患有SV的儿童）发生AIS的风险增加。患病率与过去几十年的报告相比没有变化。尽管遵循了当前的抗凝建议，但SV患者仍发生了AIS。未来的努力应集中在预防心脏病患者发生AIS的最佳实践上。
