Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb 23;5(2):e003071.
doi: 10.1161/JAHA.115.003071.

Ischemic Stroke in Children and Young Adults With Congenital Heart Disease

Zacharias Mandalenakis  1 , Annika Rosengren  2 , Georgios Lappas  2 , Peter Eriksson  2 , Per-Olof Hansson  2 , Mikael Dellborg  2
Affiliations

Ischemic Stroke in Children and Young Adults With Congenital Heart Disease

Zacharias Mandalenakis et al. J Am Heart Assoc. .

Abstract

Background: Patients with congenital heart disease (CHD) may be at increased risk of ischemic stroke due to residual shunts, arrhythmias, and other cardiovascular abnormalities. We studied the relative risk and potential factors for developing ischemic stroke in children and young adults with CHD in Sweden.

Methods and results: All patients in the Swedish Patient Register with a diagnosis of CHD, born between 1970 and 1993, were identified and compared with 10 controls for each patient, matched for age, sex, and county and randomly selected from the general population. Follow-up data through 2011 were collected for both groups. Of 25 985 children and young adults with CHD (51.5% male, 48.5% female), 140 (0.5%) developed ischemic stroke. The hazard ratio for CHD patients developing ischemic stroke was 10.8 (95% CI, 8.5-13.6) versus controls. All major Marelli groups had significantly increased risk, but because of small CHD-group sizes, only atrial septal defect/patent foramen ovale, double-inlet ventricle, and aortic coarctation displayed significantly increased risk. In multivariate analysis of CHD patients, congestive heart failure carried the highest risk for developing ischemic stroke (hazard ratio 6.9 [95% CI, 4.7-10.3]), followed by hypertension and atrial fibrillation, which were also significantly associated with increased risk of ischemic stroke.

Conclusions: The risk of developing ischemic stroke was almost 11 times higher in young patients with CHD than in the general population, although absolute risk is low. Cardiovascular comorbidities were strongly associated with the development of ischemic stroke in young CHD patients.

Keywords: epidemiology; heart defects, congenital; registry; stroke.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cumulative incidence of ischemic stroke in patients with congenital heart disease and controls for up to 42 years of follow‐up.
Figure 2
Figure 2
Cumulative incidence of ischemic stroke in overall and Marelli groups of patients with congenital heart disease (CHD) and controls for up to 42 years of age.
See this image and copyright information in PMC

Comment in

References

    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER III, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics C, Stroke Statistics S . Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292. - PMC - PubMed
    1. Biller J. Stroke: improving characterization of childhood cerebral arteriopathies. Nat Rev Cardiol. 2009;6:395–397. - PubMed
    1. Rosengren A, Giang KW, Lappas G, Jern C, Toren K, Bjorck L. Twenty‐four‐year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010. Stroke. 2013;44:2388–2393. - PubMed
    1. George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995–2008. Ann Neurol. 2011;70:713–721. - PubMed
    1. Poisson SN, Schardt TQ, Dingman A, Bernard TJ. Etiology and treatment of arterial ischemic stroke in children and young adults. Curr Treat Options Neurol. 2014;16:315. - PubMed

Publication types

MeSH terms