Brinjikji W, et al. – Researchers carried out this study to ascertain the prevalence and risk factors for silent brain infarcts (SBI) in hereditary hemorrhagic telangiectasia (HHT) patients. As compared to the general population, a similar 10% SBI prevalence in the HHT cohort was noted. However, when compared to that of the general population, the prevalence of SBI was higher in HHT patients with pulmonary arteriovenous malformations (PAVMs), especially among patients than 60 years old. They underscored the need to accurately identify, and treat PAVMs in the HHT population especially given the multiple significant, clinical consequences of SBI when appropriate.

• From January 2000 to February 2017, the researchers queried their institutional HHT database to identify HHT patients who received a baseline screening brain MRI.
• They further refined this study group by excluding patients who had a history of clinical ischemic disease as defined by having a stroke or transient ischemic attack (TIA).
• They reviewed brain MRIs for SBI.
• They collected baseline data on demographics, Curacao criteria, presence of PAVMs, and cardiovascular risk factors.
• SBI prevalence was the primary outcome.
• Also, they investigated which baseline patient characteristics were correlated with SBI through univariate chi-square and Student t tests and multivariate logistic regression analyses.

• The researchers included 353 consecutive HHT patients from January 2000 to February 2017 with a screening brain MRI and no prior history of stroke/TIA.
• SBI prevalence was 9.9% (35/353).
• Compared to non-SBI patients, SBI patients were more likely to have PAVMs (80.6 vs. 53.1%, p = 0.005).
• In the SBI group, the median age was 66 and 52 in the non-SBI group (p = 0.006).
• SBI patients had higher prevalence of hyperlipidemia (34.3 vs. 9.8%, p < 0.0001), hypertension (48.6 vs. 22.0%, p = 0.005), and tobacco use (25.7 vs. 9.8%, p = 0.005).
• In this study, no patients under 30 had SBI.
• In the PAVM group, the prevalence of SBI was 18.8% with rates of 28.6% and 10.5% in the non-PAVM group in the 60-69 age group.
• The prevalence of SBI was 21.4% overall and 27.6% in the PAVM group and 10.5% in the non-PAVM group for patients ≥70 years old.
• Factors independently correlated with SBI were PAVMs (OR 3.62, 95% CI 1.46-10.40) and increasing age (OR 1.04, 95% CI 1.01-1.07) in multivariate analysis.