eprintid: 1527094 rev_number: 40 eprint_status: archive userid: 608 dir: disk0/01/52/70/94 datestamp: 2016-11-06 05:48:01 lastmod: 2022-01-10 00:26:26 status_changed: 2017-01-04 18:25:14 type: article metadata_visibility: show creators_name: Dowling, MM creators_name: Quinn, CT creators_name: Ramaciotti, C creators_name: Kanter, J creators_name: Osunkwo, I creators_name: Inusa, B creators_name: Iyer, R creators_name: Kwiatkowski, JL creators_name: Johnson, C creators_name: Rhodes, M creators_name: Owen, W creators_name: Strouse, JJ creators_name: Panepinto, JA creators_name: Neumayr, L creators_name: Sarnaik, S creators_name: Plumb, PA creators_name: Dlamini, N creators_name: Kirkham, F creators_name: Hynan, LS creators_name: PFAST Investigators, . title: Increased prevalence of potential right-to-left shunting in children with sickle cell anaemia and stroke ispublished: pub divisions: UCL divisions: B02 divisions: D13 divisions: G26 keywords: cardiology, clinical research, sickle cell anaemia, stroke note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: 'Paradoxical' embolization via intracardiac or intrapulmonary right-to-left shunts (RLS) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (SCA), predispose to paradoxical embolization. We hypothesized that children with SCA and overt stroke (SCA + stroke) have an increased prevalence of potential RLS. We performed contrasted transthoracic echocardiograms on 147 children (aged 2-19 years) with SCA + stroke) mean age 12·7 ± 4·8 years, 54·4% male) and a control group without SCA or stroke (n = 123; mean age 12·1 ± 4·9 years, 53·3% male). RLS was defined as any potential RLS detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential RLS was significantly higher in the SCA+stroke group than controls (45·6% vs. 23·6%, P < 0·001). The odds ratio for potential RLS in the SCA + stroke group was 2·7 (95% confidence interval: 1·6-4·6) vs controls. In post hoc analyses, the SCA + stroke group had a higher prevalence of intrapulmonary (23·8% vs. 5·7%, P < 0·001) but not intracardiac shunting (21·8% vs. 18·7%, P = 0·533). SCA patients with potential RLS were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in SCA. date: 2017-01 date_type: published official_url: https://dx.doi.org/10.1111/bjh.14391 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green article_type_text: Journal Article verified: verified_manual elements_id: 1096522 doi: 10.1111/bjh.14391 lyricists_name: Kirkham, Fenella lyricists_id: FKIRK91 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: British Journal of Haematology volume: 176 number: 2 pagerange: 300-308 event_location: England issn: 1365-2141 citation: Dowling, MM; Quinn, CT; Ramaciotti, C; Kanter, J; Osunkwo, I; Inusa, B; Iyer, R; ... PFAST Investigators, .; + view all <#> Dowling, MM; Quinn, CT; Ramaciotti, C; Kanter, J; Osunkwo, I; Inusa, B; Iyer, R; Kwiatkowski, JL; Johnson, C; Rhodes, M; Owen, W; Strouse, JJ; Panepinto, JA; Neumayr, L; Sarnaik, S; Plumb, PA; Dlamini, N; Kirkham, F; Hynan, LS; PFAST Investigators, .; - view fewer <#> (2017) Increased prevalence of potential right-to-left shunting in children with sickle cell anaemia and stroke. British Journal of Haematology , 176 (2) pp. 300-308. 10.1111/bjh.14391 <https://doi.org/10.1111/bjh.14391>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/1527094/2/Dowling_Increased%20prevalence%20of%20potential%20right-to-left%20shunting%20in%20children%20with%20sickle%20cell%20anaemia%20and%20stroke.pdf