Pulsatility of middle cerebral arteries is better correlated with white matter hyperintensities than aortic stiffening
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Pulsatility of cerebral arteries and aortic stiffness have been associated with white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct. Methods: We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate- to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis. Results: Eighty-three patients (56 males, mean age 61.5 ± 11.4) participated in the study. Univariate analysis showed old age and high PI-MCA were significantly correlated with moderate- to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719. Conclusions: PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.
Abstract
Background: Pulsatility of cerebral arteries and aortic stiffness have been associated with white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct. Methods: We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate- to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis. Results: Eighty-three patients (56 males, mean age 61.5 ± 11.4) participated in the study. Univariate analysis showed old age and high PI-MCA were significantly correlated with moderate- to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719. Conclusions: PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.
참고문헌 (17)
- O'Rourke MF, "Clinical applications of arterial stiffness; definitions and reference values", Am J Hypertens, 15, pp.426~444 (2002)[DOI]
- Blacher J, "Impact of aortic stiffness on survival in end-stage renal disease", Circulation, 99, pp.2434~2439 (1999)[DOI]
- Laurent S, "Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients", Hypertension, 37, pp.1236~1241 (2001)[DOI]
- Sugawara J, "Brachial-ankle pulse wave velocity: an index of central arterial stiffness?", J Hum Hypertens, 19, pp.401~406 (2005)[DOI]
- Legarth J, "Characteristics of doppler blood-velocity waveforms in a cardiovascular in vitro model. i. the model and the influence of pulse rate", Scand J Clin Lab Invest, 49, pp.451~457 (1989)[DOI]
- Giller CA, "Transcranial doppler pulsatility in vasodilation and stenosis", J Neurosurg, 72, pp.901~906 (1990)[DOI]
- Heliopoulos I, "Association of ultrasonographic parameters with subclinical white-matter hyperintensities in hypertensive patients", Cardiovasc Psychiatry Neurol, 2012, pp.616572~ (2012)
- Mitchell GF, "Arterial stiffness, pressure and flow pulsatility and brain structure and function: the age, gene", environment susceptibility--Reykjavik study, 2011, pp.134, 3398~3407
- Kidwell CS, "Transcranial doppler pulsatility indices as a measure of diffuse small-vessel disease", J Neuroimaging, 11, pp.229~235 (2001)[DOI]
- Mok V, "Transcranial doppler ultrasound for screening cerebral small vessel disease: a community study", Stroke, 43, pp.2791~2793 (2012)[DOI]
- Henskens LH, "Increased aortic pulse wave velocity is associated with silent cerebral small-vessel disease in hypertensive patients", Hypertension, 52, pp.1120~1126 (2008)[DOI]
- Kim DH, "Association between the severity of cerebral small vessel disease, pulsatility of cerebral arteries, and brachial ankle pulse wave velocity in patients with lacunar infarction", Eur Neurol, 64, pp.247~252 (2010)[DOI]
- Xiong Y, "Operational definitions improve reliability of the age-related white matter changes scale", Eur J Neurol, 18, pp.744~749 (2011)[DOI]
- National Cholesterol Education Program (NCEP) Expert Panel on Detection, "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report", Circulation, 106, pp.3143~3421 (2002)[DOI]
- Mitchell GF, "Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage", J Appl Physiol (1985), 105, pp.1652~1660 (2008)[DOI]
- de Riva N, "Transcranial doppler pulsatility index: what it is and what it isn't", Neurocrit Care, 17, pp.58~66 (2012)[DOI]
- Webb AJ, "Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility", Stroke, 43, pp.2631~2636 (2012)[DOI]