Increasing Demand for Adult Congenital Cardiac Imaging: Trends in Imaging Modality

Background: Adult congenital heart disease (ACHD) patients are at increased risk of stroke but population level data on stroke incidence in ACHD patients are limited.Methods: A retrospective population-based cohort of ACHD patients aged 18-64 years and resident of Western Australia was created and followed from January 2000 to December 2017 using linked hospital/mortality data.Stroke incidence rates for the ACHD cohort during follow-up were calculated and compared with the general population via direct standardisation.Multivariable-adjusted predictors of stroke were investigated using a nested case-control design.Results: Among 7,916 ACHD patients, 249 (3.1%) incident strokes occurred at a median age of 47 years; 186 (2.3%) were ischaemic, 33 (0.4%) haemorrhagic and 30 (0.4%) unspecified type.Incidence of ischaemic and haemorrhagic stroke was 9times and 3-times higher, respectively, in ACHD patients than the general population.Absolute risk was low with annual rates of 0.26% (ischaemic) and 0.05% (haemorrhagic).Highest rates were observed in ACHD patients with shunt and left-sided lesions.Predictors of stroke included left-sided valve repair/replacements, shunt lesions, and traditional risk factors (hypertension, infective endocarditis, peripheral vascular disease, tobacco use).Mental health disorders and higher Charlson's comorbidity score and CHA 2 DS 2 VASc score were strongly associated with higher risk of incident stroke. Conclusion:This study provides the first populationbased stroke incidence estimates for ACHD patients in Australia, showing elevated stroke risk across different CHD lesions.Our results highlight the clinical importance of managing comorbidities, especially mental health.