Annals of Clinical Neurophysiology

  • 제20권2호
  • /
  • Pages.79-84
  • /
  • 2018
  • /
  • 2508-691X(pISSN)
  • /
  • 2508-6960(eISSN)
대한임상신경생리학회 (The Korean Society of Clinical Neurophysiology)
권호 표지
DOI QR코드

DOI QR Code

Pulsatility of middle cerebral arteries is better correlated with white matter hyperintensities than aortic stiffening

  • Lee, Sang-Hwa (Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Yerim (Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Yeongbae (Department of Neurology, Gachon University Gil Medical Center) ;
  • Lee, Ju-Hun (Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
  • 투고 : 2018.05.13
  • 심사 : 2018.06.07
  • 발행 : 2018.07.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

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 $61.5{\pm}11.4$) participated in the study. Uni-variate 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.

키워드

참고문헌

  1. O'Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 2002;15:426-444. https://doi.org/10.1016/S0895-7061(01)02319-6
  2. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434-2439. https://doi.org/10.1161/01.CIR.99.18.2434
  3. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37:1236-1241. https://doi.org/10.1161/01.HYP.37.5.1236
  4. Sugawara J, Hayashi K, Yokoi T, Cortez-Cooper MY, DeVan AE, Anton MA, et al. Brachial-ankle pulse wave velocity: an index of central arterial stiffness? J Hum Hypertens 2005;19:401-406. https://doi.org/10.1038/sj.jhh.1001838
  5. Legarth J, Thorup E. 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 1989;49:451-457. https://doi.org/10.1080/00365518909089121
  6. Giller CA, Hodges K, Batjer HH. Transcranial doppler pulsatility in vasodilation and stenosis. J Neurosurg 1990;72:901-906. https://doi.org/10.3171/jns.1990.72.6.0901
  7. Heliopoulos I, Artemis D, Vadikolias K, Tripsianis G, Piperidou C, Tsivgoulis G. Association of ultrasonographic parameters with subclinical white-matter hyperintensities in hypertensive patients. Cardiovasc Psychiatry Neurol 2012;2012:616572.
  8. Mitchell GF, van Buchem MA, Sigurdsson S, Gotal JD, Jonsdottir MK, Kjartansson O, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the age, gene/environment susceptibility--Reykjavik study. Brain 2011;134(Pt 11):3398-3407. https://doi.org/10.1093/brain/awr253
  9. Kidwell CS, el-Saden S, Livshits Z, Martin NA, Glenn TC, Saver JL. Transcranial doppler pulsatility indices as a measure of diffuse small-vessel disease. J Neuroimaging 2001;11:229-235. https://doi.org/10.1111/j.1552-6569.2001.tb00039.x
  10. Mok V, Ding D, Fu J, Xiong Y, Chu WW, Wang D, et al. Transcranial doppler ultrasound for screening cerebral small vessel disease: a community study. Stroke 2012;43:2791-2793. https://doi.org/10.1161/STROKEAHA.112.665711
  11. Henskens LH, Kroon AA, van Oostenbrugge RJ, Gronenschild EH, Fuss-Lejeune MM, Hofman PA, et al. Increased aortic pulse wave velocity is associated with silent cerebral small-vessel disease in hypertensive patients. Hypertension 2008;52:1120-1126. https://doi.org/10.1161/HYPERTENSIONAHA.108.119024
  12. Kim DH, Choi JH, Moon JS, Kim HJ, Cha JK. 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 2010;64:247-252. https://doi.org/10.1159/000319923
  13. Xiong Y, Yang J, Wong A, Wong CH, Chan SS, Li HH, et al. Operational definitions improve reliability of the age-related white matter changes scale. Eur J Neurol 2011;18:744-749. https://doi.org/10.1111/j.1468-1331.2010.03272.x
  14. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). 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 2002;106:3143-3421. https://doi.org/10.1161/circ.106.25.3143
  15. 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) 2008;105:1652-1660. https://doi.org/10.1152/japplphysiol.90549.2008
  16. de Riva N, Budohoski KP, Smielewski P, Kasprowicz M, Zweifel C, Steiner LA, et al. Transcranial doppler pulsatility index: what it is and what it isn't. Neurocrit Care 2012;17:58-66. https://doi.org/10.1007/s12028-012-9672-6
  17. Webb AJ, Simoni M, Mazzucco S, Kuker W, Schulz U, Rothwell PM. Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility. Stroke 2012;43:2631-2636. https://doi.org/10.1161/STROKEAHA.112.655837

피인용 문헌

  1. Distinct association between cerebral arterial pulsatility and subtypes of cerebral small vessel disease vol.15, pp.7, 2018, https://doi.org/10.1371/journal.pone.0236049
  2. Characterizing pulsatility in distal cerebral arteries using 4D flow MRI vol.40, pp.12, 2020, https://doi.org/10.1177/0271678x19886667