Imperial College London
Alternate

Claire L. Shovlin PhD FRCP

Faculty of Medicine, National Heart & Lung Institute

Professor of Practice (Clinical and Molecular Medicine)
 
 
 
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Contact

 

c.shovlin Website

 
 
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Location

 

534Block L Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Topiwala:2021:10.1161/STROKEAHA.120.032073,
author = {Topiwala, KK and Patel, SD and Pervez, M and Shovlin, CL and Alberts, MJ},
doi = {10.1161/STROKEAHA.120.032073},
journal = {Stroke},
pages = {E311--E315},
title = {Ischemic stroke in patients with pulmonary arteriovenous fistulas},
url = {http://dx.doi.org/10.1161/STROKEAHA.120.032073},
volume = {52},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background and Purpose:Pulmonary arteriovenous fistulas (PAVFs) are a treatable cause of acute ischemic stroke (AIS), not mentioned in current American Heart/Stroke Association guidelines. PAVFs are recognized as an important complication of hereditary hemorrhagic telangiectasia.Methods:The prevalence of PAVF and hereditary hemorrhagic telangiectasia among patients admitted with AIS in the United States (2005–2014) was retrospectively studied, utilizing the Nationwide Inpatient Sample database. Clinical factors, morbidity, mortality, and management were compared in AIS patients with and without PAVF/hereditary hemorrhagic telangiectasia.Results:Of 4 271 910 patients admitted with AIS, 822 (0.02%) were diagnosed with PAVF. Among them, 106 of 822 (12.9%) were diagnosed with hereditary hemorrhagic telangiectasia. The prevalence of PAVF per million AIS admissions rose from 197 in 2005 to 368 in 2014 (Ptrend, 0.026). Patients with PAVF were younger than AIS patients without PAVF (median age, 57.5 versus 72.5 years), had lower age-adjusted inpatient morbidity (defined as any discharge other than home; 39.6% versus 46.9%), and had lower in-hospital case fatality rates (1.8% versus 5.1%). Multivariate analyses identified the following as independent risk markers (odds ratio [95% CI]) for AIS in patients with PAVF: hypoxemia (8.4 [6.3–11.2]), pulmonary hemorrhage (7.9 [4.1–15.1]), pulmonary hypertension (4.3 [4.1–15.1]), patent foramen ovale (4.2 [3.5–5.1]), epistaxis (3.7 [2.1–6.8]), venous thrombosis (2.6 [1.9–3.6]), and iron deficiency anemia (2 [1.5–2.7]). Patients with and without PAVF received intravenous thrombolytics at a similar rate (5.9% versus 5.8%), but those with PAVF did not receive mechanical thrombectomy (0% versus 0.7%).Conclusions:Pulmonary arteriovenous fistula–related ischemic stroke represents an important younger demographic with a unique set of stroke risk markers, including treatable
AU  - Topiwala,KK
AU  - Patel,SD
AU  - Pervez,M
AU  - Shovlin,CL
AU  - Alberts,MJ
DO  - 10.1161/STROKEAHA.120.032073
EP  - 315
PY  - 2021///
SN  - 0039-2499
SP  - 311
TI  - Ischemic stroke in patients with pulmonary arteriovenous fistulas
T2  - Stroke
UR  - http://dx.doi.org/10.1161/STROKEAHA.120.032073
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000667919500001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.032073
UR  - http://hdl.handle.net/10044/1/92456
VL  - 52
ER  -
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