title: Cerebrovascular disease as a complication of cardiac transplantation.
abstract: OBJECTIVE
  To characterize the frequency, risk factors, clinical presentation and etiological subtypes of cerebrovascular diseases (CVD) following cardiac transplantation (CTX).
  
  
  METHODS
  In a retrospective review of our CTX database (period 1984-2002), we assessed demographic data, vascular risk factors, surgery and donor details. We classified ischemic stroke (IS) using the clinical criteria of the Oxfordshire Community Stroke Project and the etiological criteria of the TOAST study. Logistic regression analysis and survival curves were carried out.
  
  
  RESULTS
  CTX was performed in a total of 314 patients (age 46 +/- 14 years, 78% male) and mean follow-up was 54 +/- 57 months. Twenty-two patients (7%) presented CVD: hemorrhagic stroke in 12%, transient ischemic attack in 28% and IS in 60%. CVD were early postoperative (less than 2 weeks) in 20% of patients and late in 80%. The clinical presentation in patients with IS was total anterior circulation (23.1%), partial anterior (38.4%), lacunar (15.4%) and posterior circulation (23.1%), and the etiological classification was large artery atherosclerosis (15.4%), cardioembolism (14.4%), small vessel disease (15.4%), unusual causes (15.4%) and undetermined cause (38.4%). The only independent predictor of CVD was a prior CVD event with an odds ratio of 8.2 (95% CI, 2.2-30.2, p < 0.02). The estimated risk of CVD at 5 years was greater (p < 0.02) in patients with prior CVD (4.1%) than in those without (1.1%).
  
  
  CONCLUSIONS
  CVD are a relatively frequent complication after CTX (7%) and usually occur in the late postoperative phase. CVD prior to transplantation increase the risk of CVD after this procedure.
authors.affiliation: Stroke Unit of the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. rbelvis@hsp.santpau.es
authors.forename: Robert
authors.initials: R
authors.lastname: Belvís
authors.forename: Joan
authors.initials: J
authors.lastname: Martí-Fàbregas
authors.forename: Dolores
authors.initials: D
authors.lastname: Cocho
authors.forename: María Dolores
authors.initials: MD
authors.lastname: García-Bargo
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Franquet
authors.forename: Rolando
authors.initials: R
authors.lastname: Agudo
authors.forename: Vicenç
authors.initials: V
authors.lastname: Brosa
authors.forename: Marta
authors.initials: M
authors.lastname: Campreciós
authors.forename: Mireia
authors.initials: M
authors.lastname: Puig
authors.forename: Josep Lluis
authors.initials: JL
authors.lastname: Martí-Vilalta
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents