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Pelin Batur, MD; William J. Stewart, MD; J. Harry Isaacson, MD

Arch Intern Med. 2003;163:1821-1824.

Background  Heyde syndrome is described as the association of arteriovenous malformations (AVMs) of the gastrointestinal tract and aortic stenosis (AS); its existence, however, has been questioned. We examined whether there is an association between AVMs and AS when objective measures are used to diagnose these findings.

Methods  We identified all patients who were diagnosed with AVMs between 1990 and 2000 by means of gastrointestinal endoscopy or mesenteric angiography. We compared the prevalence of AS and mitral stenosis (MS) in the 73 patients with AVMs who also had echocardiograms. For a comparison with the general population, the prevalence of AS and MS in all patients who had echocardiograms between 1990 and 2000 was calculated (MS was chosen for comparison as a lesion with similar likelihood of prompting an echocardiographic evaluation).

Results  The prevalence of AS was 31.7% in patients with AVMs, which was significantly higher than the 14.0% found in the general population comparison group (P<.001). The prevalence of MS was 1.6% in the AVM group, which was not statistically different from the 6.0% MS prevalence in the general echocardiogram population (P = .14). Significant AS was 2.6 times more common, and severe AS was 4.1 times more common, in patients with AVMs than in the general population. Age and sex were not associated with Heyde syndrome, but the association was more prevalent in blacks.

Conclusions  Our study confirmed an association between AVMs and AS, although the etiology of the Heyde syndrome remains unclear. Clinicians need to be aware of this syndrome because it may affect their management of patients with gastrointestinal bleeding or AS.

From the Departments of General Internal Medicine (Drs Batur and Isaacson) and Cardiovascular Medicine (Dr Stewart), The Cleveland Clinic Foundation, Cleveland, Ohio. The authors have no relevant financial interest in this article.

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RELATED LETTERS

Increased Prevalence of Acquired Vascular Abnormalities of the Gastrointestinal Tract Associated With Aortic Stenosis and Other Cardiac, Pulmonary, and Vascular Diseases
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