Cerebrovascular accidents in Ebstein's anomaly

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Ebstein's anomaly (EA) is a rare congenital heart defect.
• Mechanisms and risk factors for cerebrovascular accidents (CVAs) in EA remain poorly understood.
• Clarifying CVA risks in EA is crucial for patient management.

Purpose of the Study:

• To investigate the prevalence and predictors of CVAs in a large cohort of patients with Ebstein's anomaly.
• To identify specific risk factors associated with CVA development in EA.
• To estimate the long-term incidence of CVAs in EA patients.

Main Methods:

• Retrospective review of 968 patients with confirmed EA diagnosis.
• Comparison of baseline characteristics between patients with and without prior CVA history using logistic regression.
• Cox regression analysis and Kaplan-Meier method to assess CVA predictors and incidence.

Main Results:

• 9.0% of EA patients had a history of CVA (stroke or TIA).
• Atrial septal defect/patent foramen ovale (ASD/PFO) and migraines/headaches were significantly associated with prior CVA.
• Long-term CVA incidence reached 23.5% by 70 years, with paradoxical embolism implicated.

Conclusions:

• Ebstein's anomaly patients have a substantial risk of CVAs.
• Migraines/headaches and interatrial shunts are important indicators for paradoxical embolic CVAs in EA.
• Findings highlight the need for vigilance regarding CVA risk in all patients with atrial-level shunting.