TY - JOUR
T1 - Grade of pulmonary right-to-left shunt on contrast echocardiography and cerebral complications
T2 - A striking association
AU - Velthuis, Sebastiaan
AU - Buscarini, Elisabetta
AU - Van Gent, Marco W.F.
AU - Gazzaniga, Pietro
AU - Manfredi, Guido
AU - Danesino, Cesare
AU - Schonewille, Wouter J.
AU - Westermann, Cornelis J.J.
AU - Snijder, Repke J.
AU - Mager, Johannes J.
AU - Post, Martijn C.
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Background: A pulmonary right-to-left shunt (RLS) carries the risk of cerebral paradoxical embolization and severe neurologic complications. Recognizing patients at risk is important to facilitate appropriate management strategies, but a direct relation between pulmonary shunt size and risk of complications remains controversial. This study evaluated the potential relation between pulmonary shunt grade on transthoracic contrast echocardiography (TTCE) and prevalence of cerebral manifestations in patients screened for hereditary hemorrhagic telangiectasia (HHT). Methods: We conducted a two-center, cross-sectional study of all consecutive patients screened for HHT between 2004 and 2011. Pulmonary shunt grading on TTCE (grade 0, no microbubbles; grade 1, < 30 microbubbles; grade 2, 30-100 microbubbles; grade 3, > 100 microbubbles) was performed according to contrast opacifi cation of the left ventricle. Cerebral complications were defi ned as ischemic stroke, transient ischemic attack, or brain abscess diagnosed by a neurologist and confi rmed by appropriate imaging techniques. Results: A pulmonary RLS was present in 530 out of 1,038 patients (51.1%; mean age, 44.3 ± 15.6 years; 58.6% women). The presence of a cerebral manifestation (n 5 51) differed signifi cantly among pulmonary shunt grades on TTCE: 1.4%, 0.4%, 6.5%, and 20.9% for grades 0, 1, 2 and 3, respectively. A pulmonary shunt grade 1 was not associated with an increased prevalence of cerebral manifestations (OR, 0.44; 95% CI, 0.05-4.13; P = .47), whereas pulmonary shunt grade 2 (OR, 4.78; 95% CI, 1.14-20.0; P = .03) and grade 3 (OR, 10.4; 95% CI, 2.4-45.3; P = .002) were both independent predictors for the prevalence of a cerebral ischemic event or brain abscess. Conclusions: The pulmonary RLS grade on TTCE is strongly associated with the prevalence of cerebral complications in patients screened for HHT.
AB - Background: A pulmonary right-to-left shunt (RLS) carries the risk of cerebral paradoxical embolization and severe neurologic complications. Recognizing patients at risk is important to facilitate appropriate management strategies, but a direct relation between pulmonary shunt size and risk of complications remains controversial. This study evaluated the potential relation between pulmonary shunt grade on transthoracic contrast echocardiography (TTCE) and prevalence of cerebral manifestations in patients screened for hereditary hemorrhagic telangiectasia (HHT). Methods: We conducted a two-center, cross-sectional study of all consecutive patients screened for HHT between 2004 and 2011. Pulmonary shunt grading on TTCE (grade 0, no microbubbles; grade 1, < 30 microbubbles; grade 2, 30-100 microbubbles; grade 3, > 100 microbubbles) was performed according to contrast opacifi cation of the left ventricle. Cerebral complications were defi ned as ischemic stroke, transient ischemic attack, or brain abscess diagnosed by a neurologist and confi rmed by appropriate imaging techniques. Results: A pulmonary RLS was present in 530 out of 1,038 patients (51.1%; mean age, 44.3 ± 15.6 years; 58.6% women). The presence of a cerebral manifestation (n 5 51) differed signifi cantly among pulmonary shunt grades on TTCE: 1.4%, 0.4%, 6.5%, and 20.9% for grades 0, 1, 2 and 3, respectively. A pulmonary shunt grade 1 was not associated with an increased prevalence of cerebral manifestations (OR, 0.44; 95% CI, 0.05-4.13; P = .47), whereas pulmonary shunt grade 2 (OR, 4.78; 95% CI, 1.14-20.0; P = .03) and grade 3 (OR, 10.4; 95% CI, 2.4-45.3; P = .002) were both independent predictors for the prevalence of a cerebral ischemic event or brain abscess. Conclusions: The pulmonary RLS grade on TTCE is strongly associated with the prevalence of cerebral complications in patients screened for HHT.
UR - http://www.scopus.com/inward/record.url?scp=84881508436&partnerID=8YFLogxK
U2 - 10.1378/chest.12-1599
DO - 10.1378/chest.12-1599
M3 - Article
C2 - 23429940
AN - SCOPUS:84881508436
SN - 0012-3692
VL - 144
SP - 542
EP - 548
JO - Chest
JF - Chest
IS - 2
ER -