Key result
Elevated body mass index over 25 was strongly associated with stroke as a presenting feature in adult patients with secundum ASD (OR 18.2; 95% CI 4.0-82.2; p<0.001).
Why the study?
The frequency of and risk factors for stroke as a presenting feature in adults with secundum atrial septal defect, as well as rates of post-closure atrial fibrillation and stroke, required evaluation.
What are the risk factors for stroke in adult patients with secundum ASD without atrial arrhythmias, and what are the rates of post-closure AF and stroke?
Observational (n=346)
What are the risk factors for stroke in adult patients with secundum ASD without atrial arrhythmias, and what are the rates of post-closure AF and stroke?
Odds Ratio: 18.2 (95% CI 4–82.2)
p-value: p=<0.001
In adult patients with secundum ASD without atrial arrhythmias, stroke incidence is 10%, with obesity, smoking, and prominent Eustachian valve identified as independent risk factors.
May flag higher stroke risk in secundum ASD; leaves open causal effects of weight loss.
OBJECTIVE: To evaluate the frequency of and risk factors for stroke as a presenting feature in adult patients with secundum atrial septal defect (ASD); rates of post-closure atrial fibrillation (AF) and stroke were also assessed. METHODS: We retrospectively reviewed adult patients who presented with an ASD between 2002 and 2018, excluding those with known atrial arrhythmias. Risk factors for stroke were identified using multivariable logistic regression. Post-closure stroke was evaluated using survival analysis stratified by the presence of post-procedure AF. RESULTS: Of 346 patients with ASD (median age 44 years), 34 (10%) presented with a history of stroke. Independent risk factors included elevated body mass index over 25 (OR: 18.2; 95% CI: 4.0 to 82.2; p<0.001), smoking (OR: 9.5; 95% CI: 3.8 to 23.9; p<0.001) and a prominent Eustachian valve (OR: 9.2; 95% CI: 3.4 to 25.2; p<0.001). A scoring system based on these three parameters provided robust stroke risk stratification. During a median follow-up of 12 months after closure, 12 patients (4%) experienced AF and 4 patients (1%) had a new stroke. AF was highly associated with development of stroke post-closure (p<0.001). CONCLUSIONS: In this study population, the incidence of stroke prior to ASD closure among patients without atrial arrhythmias was 10%. Risk factors included obesity, smoking and prominent Eustachian valve anatomy. Lifestyle changes should be recommended for at-risk patients, and it may be reasonable to consider ASD closure in the absence of haemodynamic indications in patients at increased risk of stroke.
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Dolgner et al. (2021) conducted an observational in Secundum atrial septal defect (n=346). Elevated body mass index over 25 vs. Body mass index 25 or less was evaluated on Stroke as a presenting feature (OR 18.2, 95% CI 4.0-82.2, p=<0.001). Elevated body mass index over 25 was strongly associated with stroke as a presenting feature in adult patients with secundum ASD (OR 18.2; 95% CI 4.0-82.2; p<0.001).
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