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Wu TW, Wu YJ, Chou CL, Cheng CF, Lu SX, Wang LY. Hemodynamic parameters and diabetes mellitus in community-dwelling middle-aged adults and elders: a community-based study. Sci Rep 2024; 14:12032. [PMID: 38797773 PMCID: PMC11128448 DOI: 10.1038/s41598-024-62866-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
Hemodynamic parameters have been correlated with stroke, hypertension, and arterial stenosis. While only a few small studies have examined the link between hemodynamics and diabetes mellitus (DM). This case-control study enrolled 417 DM patients and 3475 non-DM controls from a community-based cohort. Peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow velocity (MFV), pulsatility index (PI), and the resistance index (RI) of the common carotid arteries were measured by color Doppler ultrasonography. Generalized linear regression analyses showed that as compared to the non-DM controls, the age-sex-adjusted means of PSV, EDV, and MFV were - 3.28 cm/sec, - 1.94 cm/sec, and - 2.38 cm/sec, respectively, lower and the age-sex-adjusted means of RI and PI were 0.013 and 0.0061, respectively, higher for the DM cases (all p-values < 0.0005). As compared to the lowest quartiles, the multivariable-adjusted ORs of DM for the highest quartiles of PSV, EDV, MFV, RI, and PI were 0.59 (95% confidence interval [CI] 0.41-0.83), 0.45 (95% CI 0.31-0.66), 0.53 (95% CI 0.37-0.77), 1.61 (95% CI 1.15-2.25), and 1.58 (95% CI 1.12-2.23), respectively. More importantly, the additions of EDV significantly improved the predictabilities of the regression models on DM. As compared to the model contained conventional CVD risk factors alone, the area under the receiver operating curve (AUROC) increased by 1.00% (95% CI 0.29-1.73%; p = 0.0059) and 0.80% (95% CI 0.15-1.46%; p = 0.017) for models that added EDV in continuous and quartile scales, respectively. Additionally, the additions of PSV and MFV also significantly improved the predictabilities of the regression models (all 0.01 < p-value < 0.05). This study reveals a significant correlation between DM and altered hemodynamic parameters. Understanding this relationship could help identify individuals at higher risk of DM and facilitate targeted preventive strategies to reduce cardiovascular complications in DM patients.
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Affiliation(s)
- Tzu-Wei Wu
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan.
| | - Yih-Jer Wu
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chao-Liang Chou
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Fang Cheng
- Tamsui Health Station, Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Shu-Xin Lu
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Li-Yu Wang
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Jhong-Jheng Rd., San-Jhih District, New Taipei City, Taiwan.
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Heredia-Orbegoso O, Vences MA, Failoc-Rojas VE, Fernández-Merjildo D, Lainez-Chacon RH, Villamonte R. Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru. Front Neurol 2024; 15:1340749. [PMID: 38765265 PMCID: PMC11099257 DOI: 10.3389/fneur.2024.1340749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
Aim We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. Methods We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. Results This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). Conclusions A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.
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Affiliation(s)
- Omar Heredia-Orbegoso
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | | | | | | | - Richard H. Lainez-Chacon
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | - Renán Villamonte
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
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Stoisavljevic S, Stojanovic M, Zdraljevic M, Aleksic V, Pekmezovic T, Mijajlovic M. Correlation between Morphological and Hemodynamic Parameters of Carotid Arteries and Cerebral Vasomotor Reactivity. Brain Sci 2024; 14:167. [PMID: 38391741 PMCID: PMC10886859 DOI: 10.3390/brainsci14020167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
The function of cerebral small vessels can be assessed using cerebral vasomotor reactivity (VMR). Our aim in this retrospective cross-sectional study was to investigate a correlation between carotid artery stenosis measured through ultrasonographic morphological and hemodynamic parameters and cerebral VMR. A total of 285 patients (125 males; mean age 54) were included. The breath-holding index (BHI) was used to evaluate cerebral VMR. Ultrasonographic carotid artery parameters were collected: the presence and characteristics of carotid plaques, the degree of carotid diameter stenosis, intima-media thickness (IMT), peak systolic velocity (PSV), and end diastolic velocity (EDV). Additionally, hemodynamic parameters of the middle cerebral artery (MCA) were evaluated, including the mean flow velocity (MFV) and pulsatility index (PI). The following was collected from patients' medical histories: age, gender, and vascular risk factors. A negative correlation between the BHI and age (r = -0.242, p < 0.01), BHI and the presence of carotid plaques, BHI and IMT (r = -0.203, p < 0.01), and BHI and the PI of MCA on both sides (r = -0.268, p < 0.01) was found. We found a positive correlation between the BHI in the left MCA and EDV in the left internal carotid artery (r = 0.121, p < 0.05). This study shows the correlation between cerebral VMR and carotid stenosis but indicates a higher influence of morphological parameters on VMR values.
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Affiliation(s)
| | - Milica Stojanovic
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Mirjana Zdraljevic
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Vuk Aleksic
- Neurosurgery Department, Clinical-Hospital Center Zemun, 11000 Belgrade, Serbia
| | | | - Milija Mijajlovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Yan P, Li J, Zhang Y, Dan X, Wu X, Zhang X, Yang Y, Chen X, Li S, Chen P, Wan Q, Xu Y. Association of Circulating Carbohydrate Antigen 19-9 Level with Type 2 Diabetic Kidney Disease in Chinese Adults: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:467-477. [PMID: 38312210 PMCID: PMC10838495 DOI: 10.2147/dmso.s434972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Objective Very few and conflicting data are available regarding the correlation between circulating carbohydrate antigen 19-9 (CA19-9) levels and diabetic kidney disease (DKD) and its components including albuminuria and a low estimated glomerular filtration rate (eGFR). This study aimed to examine the association of circulating CA19-9 and DKD in Chinese patients with type 2 diabetes mellitus (T2DM). Methods A total of 402 hospitalized T2DM patients between September 2017 and December 2021 were included in this cross-sectional study. There were 224 and 178 subjects in non-DKD and DKD groups, respectively. Serum CA19-9 was measured by chemiluminescence method, and its potential relationship with DKD was evaluated by multivariate logistic regression and correlation analyses, and receiver operating characteristic (ROC) curve analysis. Results T2DM patients with DKD had significantly higher serum CA19-9 levels than those without, and serum CA19-9 levels were positively related to urinary albumin-to-creatinine ratio and negatively to eGFR (P<0.01). Multivariate regression analysis revealed that serum CA 19-9 was an independent factor of DKD [odds ratio (OR), 1.018; 95% confidence interval (CI), 1.002-1.035; P<0.05]. Moreover, an increased progressively risk of DKD with an increase in serum CA19-9 quartiles was observed (P for trend <0.001), and T2DM patients in the highest serum CA19-9 quartile were associated with an increased likelihood of DKD when compared to those in the lowest quartile (OR: 2.936, 95% CI 1.129-7.633, P<0.05). Last, the analysis of ROC curves suggested that serum CA 19-9 at a cut of 25.09 U/mL resulted in the highest Youden index with sensitivity 43.8% and 75.4% specificity to predict the presence of DKD. Conclusion These results showed that high circulating CA19-9 was related to DKD and may serve as a useful biomarker of DKD in hospitalized Chinese T2DM patients.
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Affiliation(s)
- Pijun Yan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Jia Li
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Yi Zhang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Xiaofang Dan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Xian Wu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Xing Zhang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Yuxia Yang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Xiping Chen
- Clinical medical College, Southwest Medical University, Luzhou, People's Republic of China
| | - Shengxi Li
- Clinical medical College, Southwest Medical University, Luzhou, People's Republic of China
| | - Pan Chen
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Qin Wan
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
| | - Yong Xu
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, People's Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, People's Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People's Republic of China
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Karn AK, Narayan S, Qavi A, Maurya PKK, Singh A, Kulshreshtha D. Sequential carotid Doppler study in acute stroke and its clinical correlation: A prospective study. J Neurosci Rural Pract 2024; 15:42-46. [PMID: 38476433 PMCID: PMC10927035 DOI: 10.25259/jnrp_342_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/31/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Resistive index (RI) and pulsatility index (PI) assessed on carotid Doppler assess the hemodynamic status of cranial vasculature. They are related to the severity of stroke and help determine the overall outcome. This study was done to compare the hospital stay and stroke severity with RI and PI of both internal carotid arteries. Materials and Methods Patients >18 years of age presenting within 48 h of anterior circulation stroke (either ischemic or hemorrhagic) were included. They were divided into two groups based on their length of stay (LOS). They were assessed clinically on days 1, 3, and 5, and underwent a carotid Doppler study on the same days. The Doppler parameters were correlated with the LOS and stroke severity for possible associations. Results One hundred and one patients were included. Forty-seven patients had a favorable outcome based on LOS. In this group, significant decrease in RI and PI scores was seen from days 1 to 3. In patients with unfavorable outcome, there was a significant increase in PI on days 1-3 and days 1-5. The National Institutes of Health Stroke Scale decreased significantly from days 1 to 5 in favorable group. Conclusion For those with an unfavorable outcome and prolonged LOS, PI continues to increase suggesting a failure of autoregulation. Carotid Doppler can be a simple bedside tool to predict outcome in patients with acute stroke.
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Affiliation(s)
- Ashutosh Kumar Karn
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shamrendra Narayan
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abdul Qavi
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradeep Kumar Kumar Maurya
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajai Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Ishii D, Maeda Y, Kuwabara M, Hosogai M, Kume S, Hara T, Kondo H, Horie N. Pulsatility index of superficial temporal artery was associated with cerebral infarction after direct bypass surgery for moyamoya disease. J Stroke Cerebrovasc Dis 2023; 32:107346. [PMID: 37708702 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE Direct bypass surgery by superficial temporal artery (STA) - middle cerebral artery anastomosis is an established procedure for moyamoya disease (MMD). However, some patients may develop cerebral infarction (CI) due to the watershed shift phenomenon after the surgery. This study sought to investigate the correlation between the postoperative changes of STA flow as well as cerebral blood flow (CBF) and the incidence of CI after direct bypass surgery for MMD. METHODS We conducted a retrospective study of 62 hemispheres in 50 subjects who underwent direct bypass surgery for MMD. All subjects underwent pre- and post-operative MR imaging, ultrasound evaluation of STA, and single-photon emission computed tomography. The presence of CI was correlated with preoperative CBF, the delta difference of each value of the STA between before and after the surgery, and the postoperative increase ratio of CBF. RESULTS All bypass procedures were patent, and CI was observed in 4 cases (6.4%). There was no significant association between the incidence of CI and both pre- and post-operative CBF. However, there was a significant difference in delta pulsatility index (PI) of the STA between cases with or without CI (-0.38±0.22 and -0.87±0.63, respectively, p=0.03). Whereas, other factors did not show any significant differences between those with or without CI. CONCLUSIONS A relatively high postoperative PI of the STA was significantly associated with the incidence of CI after direct bypass surgery for MMD. A larger study is needed to confirm these findings.
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Affiliation(s)
- Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Yuyo Maeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kume
- Department of Clinical Laboratory, Hiroshima University Hospital, Hiroshima, Japan
| | - Takeshi Hara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Kondo
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Meyer S, Wilde L, Wolf F, Liman J, Bähr M, Maier IL. Doppler flow morphology characteristics of epiaortic arteries in aortic valve pathologies: a retrospective study on a cohort of patients with ischemic stroke. Ultrasound J 2023; 15:29. [PMID: 37285079 DOI: 10.1186/s13089-023-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND AIMS Neurovascular ultrasound (nvUS) of the epiaortic arteries is an integral part of the etiologic workup in patients with ischemic stroke. Aortic valve disease shares similar vascular risk profiles and therefore not only presents a common comorbidity, but also an etiologic entity. The aim of this study is to investigate the predictive value of specific Doppler curve flow characteristics in epiaortic arteries and the presence of aortic valve disease. METHODS Retrospective, single-center analysis of ischemic stroke patients, both receiving full nvUS of the extracranial common- (CCA), internal- (ICA) and external carotid artery (ECA) and echocardiography (TTE/TEE) during their inpatient stay. A rater blinded for the TTE/TEE results investigated Doppler flow curves for the following characteristics: 'pulsus tardus et parvus' for aortic valve stenosis (AS) and 'bisferious pulse', 'diastolic reversal', 'zero diastole' and 'no dicrotic notch' for aortic valve regurgitation (AR). Predictive value of these Doppler flow characteristics was investigated using multivariate logistic regression models. RESULTS Of 1320 patients with complete examination of Doppler flow curves and TTE/TEE, 75 (5.7%) showed an AS and 482 (36.5%) showed an AR. Sixty-one (4.6%) patients at least showed a moderate-to-severe AS and 100 (7.6%) at least showed a moderate-to-severe AR. After adjustment for age, coronary artery disease, arterial hypertension, diabetes mellitus, smoking, peripheral arterial disease, renal failure and atrial fibrillation, the following flow pattern predicted aortic valve disease: 'pulsus tardus et parvus' in the CCA and ICA was highly predictive for a moderate-to-severe AS (OR 1158.5, 95% CI 364.2-3684.8, p < 0.001). 'No dicrotic notch' (OR 102.1, 95% CI 12.4-839.4, p < 0.001), a 'bisferious pulse' (OR 10.8, 95% CI 3.2-33.9, p < 0.001) and a 'diastolic reversal' (OR 15.4, 95% CI 3.2-74.6, p < 0.001) in the CCA and ICA predicted a moderate-to-severe AR. The inclusion of Doppler flow characteristics of the ECA did not increase predictive value. CONCLUSIONS Well defined, qualitative Doppler flow characteristics detectable in the CCA and ICA are highly predictive for aortic valve disease. The consideration of these flow characteristics can be useful to streamline diagnostic and therapeutic measures, especially in the outpatient setting.
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Affiliation(s)
- Stefanie Meyer
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Lara Wilde
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Frieder Wolf
- Department of Cardiology, University Medicine Göttingen, Göttingen, Germany
| | - Jan Liman
- Department of Neurology, Paracelsus Medical University Nuremberg Hospital, Nuremberg, Germany
| | - Mathias Bähr
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ilko L Maier
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Bill O, Mazya MV, Michel P, Prazeres Moreira T, Lambrou D, Meyer IA, Hirt L. Intima-Media Thickness and Pulsatility Index of Common Carotid Arteries in Acute Ischaemic Stroke Patients with Diabetes Mellitus. J Clin Med 2022; 12:jcm12010246. [PMID: 36615047 PMCID: PMC9821495 DOI: 10.3390/jcm12010246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Ultrasonographic parameters such as the common carotid artery (CCA) pulsatility index (PI) and CCA intima-media thickness (IMT) have been associated with an increased mortality and risk of recurrent stroke, respectively. We hypothesized that these ultrasonographic parameters may be useful for monitoring diabetic patients after an acute stroke. We analysed retrospective data of consecutive acute ischaemic stroke patients from the ASTRAL registry who underwent pre-cerebral ultrasonographic evaluation within 7 days of symptom onset. We compared clinical, demographic, radiological and ultrasonographic parameters in diabetic versus non-diabetic patients (univariable and multivariable analyses) and the association of these parameters with CCA PI and CCA IMT. We analysed 1507 carotid duplex ultrasound examinations from patients with a median age of 74 years. Cardiovascular co-morbidities, including hypertension, hypercholesterolemia, obstructive sleep apnoea syndrome, higher body-mass index (BMI) and peripheral artery disease, were associated with diabetes mellitus (DM). Diabetics were more often under antiplatelet therapy and had atrial fibrillation at admission. Diabetic patients showed an increased CCA PI and IMT in line with more atherosclerotic changes on acute CTA compared to non-diabetic patients. Taking IMT as the dependent variable in a second analysis, DM, higher age, hypertension, smoking and CCA PI were associated with higher IMT. Taking CCA PI as the dependent variable in a third analysis, DM, higher age and higher NIHSS at admission were associated with higher CCA PI values. Increased IMT was also associated with higher PI. We show that CCA PI and IMT are higher in diabetic patients in the first week after an initial stroke.
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Affiliation(s)
- Olivier Bill
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: (O.B.); (L.H.)
| | - Michael V. Mazya
- Department of Neurology, Karolinska University Hospital, 171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Tiago Prazeres Moreira
- Department of Neurology, Karolinska University Hospital, 171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Dimitris Lambrou
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Ivo A. Meyer
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Department of Old Age Psychiatry and Psychotherapy, University of Bern, 3012 Bern, Switzerland
| | - Lorenz Hirt
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: (O.B.); (L.H.)
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9
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Yoo IH, Kim JM, Han SH, Ryu J, Jung KH, Park KY. Increased pulsatility index of the basilar artery is a risk factor for neurological deterioration after stroke: a case control study. Clin Hypertens 2022; 28:27. [PMID: 35965347 PMCID: PMC9377089 DOI: 10.1186/s40885-022-00210-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Higher pulsatility of the middle cerebral artery (MCA) is known to be associated with stroke progression. We investigated whether pulsatility index (PI) of the basilar artery (BA) can predict neurological deterioration (ND) after acute cerebral infarction. Methods A total of 708 consecutive patients with acute ischemic stroke who had undergone transcranial Doppler (TCD) ultrasonography were included. ND was defined as an increase in the National Institutes of Health Stroke Scale scores by two or more points after admission. The patients were categorized into quartiles according to BA PI. Multivariable logistic regression analysis was performed to examine whether BA PI is independently associated with ND. Results BA PI was well correlated with the right (n = 474, r2 = 0.573, P < 0.001) by Pearson correlation analysis although MCA PI could not be measured from right MCA (n = 234, 33.05%) and left MCA (n = 252, 35.59%) by TCD owing to insufficient temporal bone window. Multivariable logistic regression analysis including age, sex, cerebral atherosclerosis burden, National Institutes of Health Stroke Scale at admission, and the proportion of patients with current smoking status, hypertension, diabetes mellitus, atrial fibrillation revealed that the higher BA PI (odds ratio, 3.28; confidence interval, 1.07–10.17; P = 0.038) was independently associated with ND. Conclusions BA PI, which would be identified regardless of temporal window, could predict ND among acute stroke patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00210-9.
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10
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Morton JS, Patton B, Morse CJ, El Karsh Z, Rodrigues LA, Mousseau DD, Ferguson DP, Columbus DA, Weber LP, Olver TD. Altered cerebrovascular regulation in low birthweight swine. Comp Biochem Physiol A Mol Integr Physiol 2022; 267:111163. [PMID: 35151870 DOI: 10.1016/j.cbpa.2022.111163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
Full-term low birthweight (LBW) offspring exhibit peripheral vascular dysfunction in the postnatal period; however, whether such impairments extend to the cerebrovasculature remains to be elucidated. We used a swine model to test the hypothesis that LBW offspring would exhibit cerebrovascular dysfunction at later stages of life. Offspring from 14 sows were identified as normal birthweight (NBW) or LBW and were assessed at 28 (similar to end of infancy) and 56 (similar to childhood) days of age. LBW swine had lower absolute brain mass, but demonstrated evidence of brain sparing (increased brain mass scaled to body mass) at 56 days of age. The cerebral pulsatility index, based on transcranial Doppler, was increased in LBW swine. Moreover, arterial myography of isolated cerebral arteries revealed impaired vasoreactivity to bradykinin and reduced contribution of nitric oxide (NO) to vasorelaxation in the LBW swine. Immunoblotting demonstrated a lower ratio of phosphorylated-to-total endothelial NO synthase in LBW offspring. This impairment in NO signaling was greater at 28 vs. 56 days of age. Vasomotor responses to sodium nitroprusside (NO-donor) were unaltered, while Leu31, Pro34 neuropeptide Y-induced vasoconstriction was enhanced in LBW swine. Increases in total Y1 receptor protein content in the LBW group were not significant. In summary, LBW offspring displayed signs of cerebrovascular dysfunction at 28 and 56 days of age, evidenced by altered cerebral hemodynamics (reflective of increased impedance) coupled with endothelial dysfunction and altered vasomotor control. Overall, the data reveal that normal variance in birthweight of full-term offspring can influence cerebrovascular function later in life.
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Affiliation(s)
- Jude S Morton
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Breanna Patton
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cameron J Morse
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Zeyad El Karsh
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lucas A Rodrigues
- Department of Animal and Poultry Science, College of Agriculture and Bioresources, University of Saskatchewan, Saskatoon, SK, Canada; Prairie Swine Center, Inc., Saskatoon, SK, Canada
| | - Darrell D Mousseau
- Cell Signalling Laboratory, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - David P Ferguson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Daniel A Columbus
- Department of Animal and Poultry Science, College of Agriculture and Bioresources, University of Saskatchewan, Saskatoon, SK, Canada; Prairie Swine Center, Inc., Saskatoon, SK, Canada
| | - Lynn P Weber
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - T Dylan Olver
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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11
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Sato T, Niijima A, Arai A, Maku T, Motegi H, Takahashi M, Takatsu H, Tanabe M, Komatsu T, Sakuta K, Sakai K, Terasawa Y, Umehara T, Omoto S, Murakami H, Mitsumura H, Iguchi Y. Middle Cerebral Artery Pulsatility Index Correlates with Prognosis and Diastolic Dysfunctions in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2022; 31:106296. [PMID: 35033988 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/06/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine transcranial Doppler ultrasonography (TCD) parameters related to unfavorable outcomes, and to clarify the correlations between those parameters and heart functions in acute ischemic stroke without major vessel stenoses and occlusions. MATERIALS AND METHODS Patients were selected from a comprehensive stroke center between October 2012 and June 2019. Inclusion criteria were: 1) acute ischemic stroke without major vessel stenoses and occlusions; and 2) ability to measure blood flow in the middle cerebral artery by TCD. Unfavorable outcomes were defined as a modified Rankin Scale score of 2-6 at 3 months after onset. First, we investigated TCD parameters related to unfavorable outcomes. Second, correlations between those parameters and heart functions as assessed by transthoracic echocardiography were evaluated. RESULTS We screened 1,527 consecutive ischemic stroke patients, including 130 patients (109 [83%] male; median age, 60 years). Middle cerebral artery pulsatility index (M1 PI) (Odds ratio (OR) 0.057, 95%confidence interval (CI) 0.007-0.494, p = 0.009) was independently associated with unfavorable outcomes. Concerning the relation between M1 PI and heart functions, peak early filling velocity/velocity of mitral annulus early diastolic motion (E/e') (OR 1.195, 95%CI 1.011-1.413, p = 0.037) was a factor independently associated with high M1 PI. CONCLUSIONS High M1 PI predicts unfavorable outcome regardless of ischemic stroke subtype without major vessel stenoses and occlusions. High M1 PI correlates with high E/e', suggesting diastolic dysfunction.
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Affiliation(s)
- Takeo Sato
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan.
| | - Akira Niijima
- Department of Cardiology, the Jikei University School of Medicine, Tokyo, Japan
| | - Ayumi Arai
- Department of Radiology, the Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Maku
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiko Motegi
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Maki Takahashi
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Takatsu
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Maki Tanabe
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Komatsu
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Sakuta
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Yuka Terasawa
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Umehara
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Shusaku Omoto
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Hidetomo Murakami
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Hidetaka Mitsumura
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
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12
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Kešnerová P, Školoudík D, Herzig R, Netuka D, Szegedi I, Langová K. Peripheral Vascular Resistance in Cerebral Arteries in Patients With Carotid Atherosclerosis - Substudy Results of the Atherosclerotic Plaque Characteristics Associated With a Progression Rate of the Plaque and a Risk of Stroke in Patients With the Carotid Bifurcation Plaque Study (ANTIQUE). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:237-246. [PMID: 33792942 DOI: 10.1002/jum.15703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Transcranial color-coded duplex sonography (TCCS) enables to measure blood flow characteristics in cerebral vessels, including vascular resistance and pulsatility. The study aims to identify factors influencing pulsatility (PI) and resistance (RI) indices measured using TCCS in patients with carotid atherosclerosis. METHODS Self-sufficient patients with atherosclerotic plaque causing 20-70% carotid stenosis were consecutively enrolled to the study. All patients underwent duplex sonography of cervical arteries and TCCS with measurement of PI and RI in the middle cerebral artery, neurological, and physical examinations. Following data were recorded: age, gender, height, weight, body mass index, systolic and diastolic blood pressure, occurrence of current and previous diseases, surgery, medication, smoking, and daily dose of alcohol. Univariant and multivariant logistic regression analysis were used for identification of the factors influencing RI and PI. RESULTS Totally 1863 subjects were enrolled to the study: 139 healthy controls (54 males, age 55.52 ± 7.05 years) in derivation cohort and 1724 patients (777 males, age 68.73 ± 9.39 years) in validation cohort. The cut off value for RI was 0.63 and for PI 1.21. Independent factors for increased RI/PI were age (odds ratio [OR] = 1.108/1.105 per 1 year), occurrence of diabetes mellitus (OR = 1.767/2.170), arterial hypertension (OR = 1.700 for RI only), width of the carotid plaque (OR = 1.260 per 10% stenosis for RI only), and male gender (OR = 1.530 for PI only; P ˂.01 in all cases). CONCLUSIONS The independent predictors of increased cerebral arterial resistance and/or pulsatility in patients with carotid atherosclerosis were age, arterial hypertension, diabetes mellitus, carotid plaque width, and male gender.
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Affiliation(s)
- Petra Kešnerová
- Department of Neurology, Comprehensive Stroke Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurology, Comprehensive Stroke Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Školoudík
- Department of Neurology, Comprehensive Stroke Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Center for Health Research, Ostrava University Medical Faculty, Ostrava, Czech Republic
- Department of Neurology, Stroke Center, Vítkovice Hospital, Ostrava, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - David Netuka
- Department of Neurosurgery, First Faculty of Medicine and University Military Hospital Prague, Prague-Střešovice, Czech Republic
| | - Istvan Szegedi
- Department of Neurology, Debrecen University Faculty of Medicine and University Hospital Debrecen, Debrecen, Hungary
| | - Kateřina Langová
- Department of Biophysics, Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacký University, Olomouc, Czech Republic
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13
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Purroy F, Sánchez E, Lecube A, Arqué G, Vicente-Pascual M, Mauri-Capdevila G, Torreguitart N, Hernández M, Barbé F, Fernández E, Pamplona R, Farràs C, Mauricio D, Bermúdez-López M. Prevalence and Predictors of Cerebral Microangiopathy Determined by Pulsatility Index in an Asymptomatic Population From the ILERVAS Project. Front Neurol 2022; 12:785640. [PMID: 34970215 PMCID: PMC8712482 DOI: 10.3389/fneur.2021.785640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about the prevalence of cerebral microangiopathy (CM), which is related to cognitive impairment, in an asymptomatic population. Pulsatility index (PI) is an easily measurable parameter of cerebral vascular resistance in transcranial duplex of the middle cerebral artery (MCA) study. We aimed to determine the prevalence of CM measured by PI of MCA in low to moderate vascular risk subjects. Methods: We included 3,721 subjects between 45 and 70 years without previous history of vascular disease or diabetes mellitus and with at least one other vascular risk factor from the cross-sectional study ILERVAS (Lleida, Spain). Patients underwent transcranial duplex to determine MCA-PI. Possible CM was defined by MCA-PI >1.1. Carotid and femoral arteries ultrasound registration was done to determine the presence, the number, and the area of atheromatous plaques. Body mass index (BMI), pulse pressure (PP) and laboratory data were also recorded. Results: 439 (11.8%) subjects were excluded due to the low quality of transcranial duplex images. Median age was 57 [IQR 52, 62] years. Possible CM was found in 424 (12.9%) subjects. CM patients had higher prevalence of plaques than non-CM (77.4 vs. 66.4%, p < 0.001). PI showed a positive linear correlation with the number of territories with plaques (r = 0.130, p < 0.001), and the total plaque area (r = 0.082, p < 0.001). The predictors of possible CM were the age, male gender, and PP. Conclusions: In low-to-moderate vascular risk asymptomatic population, the proportion of abnormal brain microvascular bed determined by MCA-PI is not negligible. The planned 10-year follow-up will describe the clinical relevance of these findings.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, University Hospital Arnau de Vilanova, Lleida, Spain.,Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Gloria Arqué
- Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | | | - Gerard Mauri-Capdevila
- Stroke Unit, University Hospital Arnau de Vilanova, Lleida, Spain.,Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Núria Torreguitart
- Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain.,Vascular Surgery Service, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain
| | - Ferrán Barbé
- Pneumology Service, Translational Research in Respiratory Medicine Research Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Lleida, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III (ISCIII), Lleida, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, IRBLleida, ReinRen-ISCIII, University of Lleida, Lleida, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, Metabolic Pathophysiology Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Cristina Farràs
- DAP Lleida, Unitat de Suport a la Recerca - IDIAP Jordi Gol, Lleida, Spain
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain
| | - Marcelino Bermúdez-López
- Vascular and Renal Translational Research Group, IRBLleida, ReinRen-ISCIII, University of Lleida, Lleida, Spain
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14
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Hitomi Y, Masaki N, Ishinoda Y, Kagami K, Yasuda R, Toya T, Namba T, Nagatomo Y, Takase B, Adachi T. Effectiveness of pulsatility index of carotid Doppler ultrasonography to predict cardiovascular events. J Med Ultrason (2001) 2022; 49:95-103. [PMID: 34778938 DOI: 10.1007/s10396-021-01164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The pulsatility index (PI) obtained from carotid ultrasonography is considered to be a marker of cerebrovascular resistance. However, the impact of PI on cardiovascular events has yet to be fully addressed. METHOD Fifty-four patients who underwent both carotid ultrasonography and coronary angiography were followed for 5.9 ± 3.2 years. The relationship between the incidence of cardiovascular events and PI was investigated. RESULT There were 10 (19%) deaths, four (7%) cardiovascular deaths, and nine (17%) major adverse cardiovascular events (MACEs). The cardiovascular events-defined as all hospitalization for MACEs plus heart failure, revascularization, and cardiovascular surgery-occurred in 21 patients (39%). The patients were divided into two groups according to each threshold of PI value for common carotid arteries (CCA), internal carotid arteries (ICA), and external carotid arteries (ECA), respectively. The thresholds were calculated based on receiver-operating characteristic curves for cardiovascular events. Log-rank test showed that the groups with CCA-PI ≥ 1.71, ICA-PI ≥ 1.20, and ECA-PI ≥ 2.46 had a higher incidence of cardiovascular events, respectively (p < 0.05). ECA-PI ≥ 2.46 was associated with an increased incidence of MACEs. Multivariate Cox regression analysis adjusting for cardiovascular risk factors showed that high PI of CCA, ICA, or ECA was a risk factor for cardiovascular events, respectively (CCA-PI ≥ 1.71, hazard ratio (HR) 3.242, p = 0.042; ICA-PI ≥ 1.20, HR 3.639, p = 0.012; ECA-PI ≥ 2.46, HR 11.322, p = 0.001). CONCLUSION The results suggested that carotid PIs were independent predictive factors for further cardiovascular events. In particular, high ECA-PI levels may reflect severe arteriosclerosis.
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Affiliation(s)
- Yasuhiro Hitomi
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan.
| | - Yuki Ishinoda
- Department of Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Kazuki Kagami
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Risako Yasuda
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
- Department of Intensive Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Takayuki Namba
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Bonpei Takase
- Department of Intensive Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
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15
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Sasaki N, Maeda R, Ozono R, Nakano Y, Higashi Y. Association of Flow Parameters and Diameter in the Common Carotid Artery with Impaired Glucose Metabolism. J Atheroscler Thromb 2021; 29:654-666. [PMID: 34011802 PMCID: PMC9135665 DOI: 10.5551/jat.62790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Diameter, intima-media thickness (IMT), and flow parameters, including resistance index (RI) and pulsatility index (PI), in the common carotid artery (CCA) are markers of arterial remodeling, atherosclerosis, and vascular resistance, respectively. We investigated the differences among these markers in association with plasma glucose level, serum insulin level, and insulin resistance in participants without cardiovascular disease. METHODS CCA parameters (including the CCA interadventitial diameter and mean IMT at the time of 75-g oral glucose tolerance testing) were assessed in 4218 participants. RI and PI were assessed in 3380 of these participants. To assess plasma glucose and serum immunoreactive insulin profiles during oral glucose tolerance testing, we used the total areas under the curves (AUCglu and AUCins, respectively). We used the homeostasis model assessment of insulin resistance (HOMA-IR) and the Matsuda index to assess insulin resistance. Insulin secretion was assessed with the HOMA-β. RESULTS AUCglu was significantly associated with CCA interadventitial diameter (β=0.048, P<0.001), RI (β=0.144, P<0.001), and PI (β=0.103, P<0.001) but not with mean IMT. AUCins (β=-0.064, P<0.001) and HOMA-β (β=-0.054, P<0.001) were significantly and negatively associated with CCA interadventitial diameter, but not with mean IMT. Both HOMA-IR and Matsuda index were significantly associated with RI and PI. CONCLUSIONS These findings indicate that all CCA parameters except IMT are associated with impaired glucose metabolism in patients without cardiovascular disease.
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Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
| | - Ryo Maeda
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
| | - Ryoji Ozono
- Department of General Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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16
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Guo Z, Wu X, Fan W. Clarifying the effects of diabetes on the cerebral circulation: Implications for stroke recovery and beyond. Brain Res Bull 2021; 171:67-74. [PMID: 33662495 DOI: 10.1016/j.brainresbull.2021.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Given the sheer increased number of victims per year and the availability of only one effective treatment, acute ischemic stroke (AIS) remains to be one of the most under-treated serious diseases. Diabetes not only increases the incidence of ischemic stroke, but amplifies the ischemic damage, upon which if patients with diabetes suffer from stroke, he/she will confront increased risks of long-term functional deficits. The grim reality makes it a pressing need to intensify efforts at the basic science level to understand how diabetes impairs stroke recovery. This review retrospects the clinical and experimental studies in order to elucidate the detrimental effect of diabetes on cerebrovascular circulation including the major arteries/arterioles, collateral circulation, and neovascularization to shed light on further exploration of novel strategies for cerebral circulation protection before and after AIS in patients with diabetes.
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Affiliation(s)
- Zhihui Guo
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Xuqing Wu
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Wei Fan
- Department of Neurology, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.
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17
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An Evaluation Using Colored Doppler Ultrasonography of Central Retinal Artery Hemodynamics in the Healthy Eye in Individuals With Late Monocular Blindness. Ultrasound Q 2020; 36:280-283. [PMID: 32890331 DOI: 10.1097/ruq.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Structural and functional changes occur in the brain after vision losses. The purpose of the present study was to investigate central retinal artery (CRA) hemodynamics in the healthy eye of individuals developing late monocular blindness (LMB) using colored Doppler ultrasonography.The CRAs of 13 healthy eyes of 13 patients with LMB and of 13 healthy individuals as a control group were evaluated in this prospective study. Peak systolic velocity, end-diastolic velocity, mean flow velocity, systolic/diastolic velocity ratio, and resistivity and pulsatility index (RI, PI) values in the CRAs were determined using colored Doppler ultrasonography in both groups.The mean age of all the individuals examined was 39.3 ± 12.3 years, and loss of vision in the LMB patients had been present for a mean 22 ± 13.2 years. The PSH, DHS, and mean flow velocity values in the LMB group were 13.3 ± 2.5 cm/s, 3.1 ± 0.8 cm/s, and 6.5 ± 1.6 cm/s, respectively, significantly lower than in the control group at 18.6 ± 5 cm/s, 5.5 ± 2.8 cm/s, and 10 ± 3.2 cm/s (P < 0.05). The PI, RI, and systolic/diastolic velocity ratio values differences in the both group were not statistically significant (P > 0.05).In conclusion, the absence of a significant difference in RI and PI values between the 2 groups revealed that vascular resistance did not develop in the CRA hemodynamics of healthy eyes of individuals with LMB, although the low velocity values showed an increase in CRA width.
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18
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Chodzyǹski KJ, Uzureau P, Nuyens V, Rousseau A, Coussement G, Zouaoui Boudjeltia K. The impact of arterial flow complexity on flow diverter outcomes in aneurysms. Sci Rep 2020; 10:10337. [PMID: 32587308 PMCID: PMC7316819 DOI: 10.1038/s41598-020-67218-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/28/2020] [Indexed: 12/03/2022] Open
Abstract
The flow diverter is becoming a standard device for treating cerebral aneurysms. The aim of this in vitro study was to evaluate the impact of flow complexity on the effectiveness of flow diverter stents in a cerebral aneurysm model. The flow pattern of a carotid artery was decomposed into harmonics to generate four flow patterns with different pulsatility indexes ranging from 0.72 to 1.44. The effect of flow diverters on the aneurysm was investigated by injecting red dye or erythrocytes as markers. The recorded images were postprocessed to evaluate the maximum filling of the aneurysm cavity and the washout time. There were significant differences in the cut-off flows between the markers, linked to the flow complexity. Increasing the pulsatility index altered the performance of the flow diverter. The red dye was more sensitive to changes in flow than the red blood cell markers. The flow cut-off depended on the diverter design and the diverter deployment step was crucial for reproducibility of the results. These results strongly suggest that flow complexity should be considered when selecting a flow diverter.
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Affiliation(s)
- Kamil Jerzy Chodzyǹski
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium.
| | - Pierrick Uzureau
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
| | - Vincent Nuyens
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
| | - Alexandre Rousseau
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
| | | | - Karim Zouaoui Boudjeltia
- Laboratoire de Médecine Expérimentale (ULB222), CHU Charleroi, Université Libre de Bruxelles, 6110, Montigny le Tilleul, Belgium
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19
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Sasaki N, Yamamoto H, Ozono R, Maeda R, Kihara Y. Association of Common Carotid Artery Measurements with N-terminal Pro B-type Natriuretic Peptide in Elderly Participants. Intern Med 2020; 59:917-925. [PMID: 31787700 PMCID: PMC7184082 DOI: 10.2169/internalmedicine.3780-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Numerous studies have reported an association between common carotid artery (CCA) parameters and atherosclerotic cardiovascular disease (CVD). However, the association between CCA parameters and hemodynamic stress on the left ventricle in elderly patients remains unclear. Methods We assessed CCA parameters, including the height-adjusted CCA interadventitial diameter (diameter/height), mean intima-media thickness (IMT), number of plaques, plaque score, resistance index (RI), and pulsatility index (PI) with ultrasonography, using serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels as a marker for hemodynamic stress on the left ventricle in 1,315 participants ≥70 years old without CVD. Of these participants, 706 had hypertension, defined as taking antihypertensive medications, having a systolic blood pressure ≥140 mmHg, and/or having a diastolic blood pressure ≥90 mmHg. Results After adjusting for the confounding factors, the CCA interadventitial diameter/height was significantly associated with the log NT-proBNP in both the normotensive group (β=0.125, p=0.002) and hypertensive group (β=0.080, p=0.029). The RI was significantly associated with the log NT-proBNP in the hypertensive group (β=0.176, p<0.001) but not in the normotensive group. In addition, the PI was significantly associated with the log NT-proBNP in the hypertensive group (β=0.156, p<0.001) but not in the normotensive group. However, no significant association was observed between the mean IMT, number of plaques, and plaque score and log NT-proBNP. Conclusion CCA measurements may be useful markers for hemodynamic stress on the left ventricle in elderly patients.
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Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council, Japan
| | - Hideya Yamamoto
- Laboratory of Physiology and Morphology, School of Pharmacy, Yasuda Women's University, Japan
| | - Ryoji Ozono
- Department of General Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Ryo Maeda
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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20
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Kwater A, Gąsowski J, Wizner B, Kasprzyk Z, Cwynar M, Rewiuk K, Grodzicki T. Cardiovascular risk factors as determinants of cerebral blood flow - a cross-sectional and 6-year follow-up study. Blood Press 2020; 29:182-190. [PMID: 31983242 DOI: 10.1080/08037051.2020.1715785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The parameters of cerebral blood flow are modulated by many factors. The aim of the study was to prospectively assess the relationship between the number of the established cardiovascular risk factors and hemodynamic parameters of cerebral blood flow.Material and methods: The study was cross-sectional baseline and 6-year follow-up data analysis. We analyzed data regarding cardiovascular risk factors, medications use, and ultrasonographically (transcranial Doppler) obtained mean cerebral blood flow velocity (mCBFV), pulsatility (PI), resistance (RI) indexes of middle cerebral artery.Results: After 6.0 ± 0.6 years of follow-up, there was increase in systolic (p = .047), and decrease in diastolic (p = .005) blood pressure, resulting in greater pulse pressure (p < .001). Although intima-media thickness increased during follow-up (p = .019), PI, RI and mCBFV did not differ between baseline and follow-up. In the cohort without follow-up (n = 112), we observed strong association between number of studied cardiovascular risk factors and lower mCBFV, and higher PI and RI (all p < .001), in the cohort with 6 year follow-up (n = 53), we confirmed similar association for mCBFV and PI (p = .002) at baseline, and mCBFV (p = .024) after follow-up. During follow-up, more patients were treated with vasoactive medications (p < .05). Also the median (interquartile range) of total number of taken drugs at follow-up 2 (1-3) was greater than at baseline 1 (0-2), (p < .001). The addition of vasoactive medications during follow-up was associated with increase of the mCBFV (0.012 ± 0.02 m/s, p = .013).Conclusion: The parameters of the cerebral blood flow are adversely influenced by accretion of cardiovascular risk factors, both at baseline and after 6 years of follow-up. The addition of a vasoactive medication during follow-up is associated with an increase of the mCBFV, a possibly beneficial effect.
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Affiliation(s)
- Aleksander Kwater
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Wizner
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Marcin Cwynar
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Rewiuk
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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21
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Hitsumoto T. Relationships Between the Cardio-Ankle Vascular Index and Pulsatility Index of the Common Carotid Artery in Patients With Cardiovascular Risk Factors. J Clin Med Res 2019; 11:593-599. [PMID: 31413771 PMCID: PMC6681855 DOI: 10.14740/jocmr3914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/13/2019] [Indexed: 01/18/2023] Open
Abstract
Background Pulsatility index (PI) is a hemodynamic parameter determined using Doppler sonography; it reflects the degree of peripheral vascular resistance. Moreover, researchers have reported significant relationships between an increase in the PI of the common carotid artery (CCA) and ischemic stroke. This cross-sectional study aimed to clarify the relationships between cardio-ankle vascular index (CAVI) as a marker of arterial stiffness and the PI of the CCA in patients with cardiovascular risk factors for the primary prevention of ischemic stroke. Methods A total of 405 outpatients undergoing treatment for cardiovascular risk factors (152 men and 253 women; mean age ± standard deviation, 64 ± 9 years) with no history of cardiovascular events, including ischemic stroke, were enrolled. The CAVI and the PI of the CCA were measured using commercial devices, and their relationships to various clinical parameters were examined. Results A significant positive correlation was observed between the CAVI and the PI of the CCA (r = 0.44, P < 0.001). Further, multiple regression analysis revealed that the CAVI (β = 0.19, P < 0.001) was selected as independent factor for PI of the CCA as a subordinate factor. Meanwhile, high-sensitivity C-reactive protein, as an inflammation marker, and skin autofluorescence, as a marker of advanced glycation end products in the tissues, were selected as independent variables for either the CAVI or the PI of the CCA as a subordinate factor. The receiver-operating characteristic curve analysis indicated that the cut-off point of the CAVI for high PI of the CCA (> 1.60) as a risk value of stroke incidence by previous report was 9.1 (area under the curve = 0.750, P < 0.001). Conclusion The present results indicate that the CAVI reflects cerebrovascular resistance in patients with cardiovascular risk factors. Moreover, the risk value of the CAVI for ischemic stroke incidence was considered to be 9.1 in these patients.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan.
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22
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Nowaczewska M, Kamińska A, Kukulska-Pawluczuk B, Junik R, Pawlak-Osińska K. Effect of hyperglycemia on cerebral blood flow in patients with diabetes. Diabetes Res Clin Pract 2019; 153:1-5. [PMID: 31145928 DOI: 10.1016/j.diabres.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/22/2019] [Accepted: 05/20/2019] [Indexed: 01/19/2023]
Abstract
AIMS Diabetes interferes with cerebral blood flow (CBF) and it seems that the effect of acute hyperglycemia on CBF is different from the changes in CBF caused by chronic diabetes. The aim of the study was to check whether there are changes in CBF measured using transcranial Doppler (TCD) in patients with hyperglycemia before and after normalization of glycemia. METHODS The study involved 29 patients with diabetes and 27 healthy subjects (control group). The TCD test evaluated mean flow velocity (Vm), systolic velocity (Vs) and Gosling's pulsatility index (PI) in both middle cerebral arteries (MCAs). It was performed twice in patients with diabetes (during hyperglycemia and after normalization of glycemia) and once in the control group. RESULTS The baseline blood flow parameters were similar in both groups. After the normalization of glycemia in patients with diabetes, they showed lower values of Vm and Vs compared to the control group (p < 0.001). Also, the normalization of glycemia caused a decrease in Vm and Vs (p < 0.001) in patients with diabetes. There were no significant differences in PI. CONCLUSIONS In the patients with hyperglycemia, Vm and Vs in the MCA were higher than during normoglycemia, which was probably related to vasoconstriction and hypervolemia.
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Affiliation(s)
- Magdalena Nowaczewska
- Department of Neurology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland; Department of Pathophysiology of Hearing and Balance, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
| | - Anna Kamińska
- Department of Endocrinology and Diabetology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Beata Kukulska-Pawluczuk
- Department of Neurology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Katarzyna Pawlak-Osińska
- Department of Pathophysiology of Hearing and Balance, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
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Akazawa N, Tanahashi K, Kosaki K, Ra SG, Matsubara T, Choi Y, Zempo-Miyaki A, Maeda S. Aerobic exercise training enhances cerebrovascular pulsatility response to acute aerobic exercise in older adults. Physiol Rep 2019; 6:e13681. [PMID: 29687959 PMCID: PMC5913713 DOI: 10.14814/phy2.13681] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 01/09/2023] Open
Abstract
The brain's low resistance ensures a robust blood flow throughout systole and diastole and is susceptible to flow pulsatility. Increased cerebral pulsatility contributes to the progression of cerebrovascular disease. Although aerobic exercise affects vascular function, little is known about the effect of exercise on the cerebral pulsatility index in older adults. The aim of this study was to investigate the effect of exercise training on the post‐exercise cerebral pulsatility response in older adults. Ten healthy older adults participated in a 12‐week exercise training intervention. Before and after the intervention, we measured the pulsatility index of the middle cerebral artery by means of transcranial Doppler method at baseline and following a cycling exercise bout performed at an intensity corresponding to the ventilatory threshold. Before exercise training, there was no significant change in the cerebral pulsatility response to an acute bout of cycling exercise. However, after the intervention, cerebral pulsatility decreased significantly following 30 min of an acute cycling exercise (P < 0.05). This study demonstrated that cerebral pulsatility index did not change following an acute bout of cycling exercise at an intensity corresponding to ventilatory threshold, but that, after 12 weeks of exercise training, cerebral pulsatility index was reduced at 30 min after a single bout of cycling exercise. These results suggest that long‐term aerobic exercise training may enhance the post‐exercise reduction in pulsatility index in older adults.
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Affiliation(s)
- Nobuhiko Akazawa
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.,Japan Institute of Sport Sciences, Kita-ku, Tokyo, Japan
| | - Koichiro Tanahashi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Keisei Kosaki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.,Japanese Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Song-Gyu Ra
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.,Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
| | - Tomoko Matsubara
- Japanese Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan.,Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
| | - Youngju Choi
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Asako Zempo-Miyaki
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Faculty of Health and Sport Sciences, Ryutsu Keizai University, Ibaraki, Japan
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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24
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Asgharzadeh H, Borazjani I. A non-dimensional parameter for classification of the flow in intracranial aneurysms. I. Simplified geometries. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2019; 31:031904. [PMID: 30967744 PMCID: PMC6435374 DOI: 10.1063/1.5033942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/04/2018] [Indexed: 05/21/2023]
Abstract
Non-dimensional parameters are routinely used to classify different flow regimes. We propose a non-dimensional parameter, called Aneurysm number (An), which depends on both geometric and flow characteristics, to classify the flow inside aneurysm-like geometries (sidewalls and bifurcations). The flow inside aneurysm-like geometries can be widely classified into (i) the vortex mode in which a vortex ring is formed and (ii) the cavity mode in which a stationary shear layer acts similar to a moving lid of a lid-driven cavity. In these modes, two competing time scales exist: (a) a transport time scale, T t , which is the time scale to develop a shear layer by transporting a fluid particle across the expansion region, and (b) the vortex formation time scale,T v . Consequently, a relevant non-dimensional parameter is the ratio of these two time scales, which is called Aneurysm number: An = T t /T v . It is hypothesized, based on this definition, that the flow is in the vortex mode if the time required for vortex ring formationT v is less than the transport time T t (An ≳ 1). Otherwise, the flow is in the cavity mode (An ≲ 1). This hypothesis is systematically tested through numerical simulations on simplified geometries and shown to be true through flow visualizations and identification of the main vortex and shear layer. The main vortex is shown to evolve when An ≳ 1 but stationary when An ≲ 1. In fact, it is shown that the flows with An ≲ 1 (cavity mode) are characterized by much smaller fluctuations of wall shear stress and oscillatory shear index relative to flows with An ≳ 1 (vortex mode) because of their quasi-stationary flow pattern (cavity mode) compared to the evolution and breakdown of the formed vortex ring (vortex mode).
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Affiliation(s)
- Hafez Asgharzadeh
- Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York 14260, USA
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25
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Asgharzadeh H, Asadi H, Meng H, Borazjani I. A non-dimensional parameter for classification of the flow in intracranial aneurysms. II. Patient-specific geometries. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2019; 31:031905. [PMID: 30967745 PMCID: PMC6436177 DOI: 10.1063/1.5081451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/14/2019] [Indexed: 05/21/2023]
Abstract
A simple parameter, called the Aneurysm number (An) which is defined as the ratio of transport to vortex time scales, has been shown to classify the flow mode in simplified aneurysm geometries. Our objective is to test the hypothesis that An can classify the flow in patient-specific intracranial aneurysms (IA). Therefore, the definition of this parameter is extended to anatomic geometries by using hydraulic diameter and the length of expansion area in the approximate direction of the flow. The hypothesis is tested using image-based flow simulations in five sidewall and four bifurcation geometries, i.e., if An ≲ 1 (shorter transport time scale), then the fluid is transported across the neck before the vortex could be formed, creating a quasi-stationary shear layer (cavity mode). By contrast, if An ≳ 1 (shorter vortex time scale), a vortex is formed. The results show that if An switches from An ≲ 1 to An ≳ 1, then the flow mode switches from the cavity mode to the vortex mode. However, if An does not switch, then the IAs stay in the same mode. It is also shown that IAs in the cavity mode have significantly lower An, temporal fluctuations of wall shear stress and oscillatory shear index (OSI) compared to the vortex mode (p < 0.01). In addition, OSI correlates with An in each flow mode and with pulsatility index in each IA. This suggests An to be a viable hemodynamic parameter which can be easily calculated without the need for detailed flow measurements/ simulations.
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Affiliation(s)
- Hafez Asgharzadeh
- Department of Mechanical and Aerospace
Engineering, University at Buffalo, The State University of New York,
Buffalo, New York 14260, USA
| | - Hossein Asadi
- J. Mike Walker ’66 Department of Mechanical
Engineering, Texas A&M University, College Station, Texas 77843,
USA
| | - Hui Meng
- Department of Mechanical and Aerospace
Engineering, University at Buffalo, The State University of New York,
Buffalo, New York 14260, USA
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26
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Cerebral and skin microcirculatory dysfunction in type 1 diabetes. Postepy Dermatol Alergol 2019; 36:44-50. [PMID: 30858778 PMCID: PMC6409882 DOI: 10.5114/ada.2018.81185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction An increase in cerebral pulsatility index (PI), measured by transcranial Doppler, reflects the presence of cerebral microangiopathy. A decrease in distance between skin capillaries (DISTANCE) and an increase in the ratio between the area of capillaries and total area of examined skin (COVERAGE), revealed by capillaroscopy, reflects skin microangiopathy. However, little is known about the association between the cerebral and skin microvasculature function in patients at risk of microcirculatory dysfunction. Aim To assess PI of the middle cerebral artery by transcranial Doppler and the DISTANCE and COVERAGE of the nailfold capillaries by quantitative capillaroscopy in patients with type 1 diabetes and control subjects without diabetes, and to investigate relationships between these parameters. Material and methods The study group consisted of 51 patients with type 1 diabetes (median age: 37.5 years) and 23 volunteers free from chronic diseases (median age: 37.9 years). Results Median PI was higher in patients than in control subjects (0.82 vs. 0.75; p < 0.01). Median DISTANCE was lower in patients than in control subjects (220.9 µm vs. 239.7 µm; p = 0.03), while median COVERAGE was higher in patients than in control subjects (20.4% vs. 18.3%; p = 0.01). No correlations between PI and DISTANCE or COVERAGE were found, but PI was correlated with patients’ age and diabetes duration. Conclusions In spite of simultaneous presence of cerebral and skin microangiopathy, we found no association between cerebral and skin microvasculature dysfunction. This seems to indicate independent progression of microcirculatory injury in cerebral and peripheral vascular beds.
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Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients. PLoS One 2019; 14:e0208918. [PMID: 30601840 PMCID: PMC6314577 DOI: 10.1371/journal.pone.0208918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Etiology is unknown in approximately one-quarter of stroke patients after evaluation, which is termed cryptogenic stroke (CS). The prognosis of CS patients is largely undetermined. We created a novel index from transcranial Doppler parameters including mean flow velocity (MV) and pulsatility index (PI) and investigated whether the calculation of asymmetry in the novel parameter can predict functional outcomes in CS patients. METHODS We made the middle cerebral artery (MCA) index (%) as a novel parameter, which was calculated as 100 X (MCA MV + MCA PI X 10) / (MCA MV-MCA PI X 10). The MCA asymmetry index (%) was also calculated as 100 X (|Rt MCA index-Lt MCA index|) / (Rt MCA index + Lt MCA index) / 2. Poor functional outcomes were defined as modified Rankin Scale score (mRS) ≥3 at 3 months after stroke onset. RESULTS A total of 377 CS patients were included. Among them, 52 (13.8%) patients had a poor outcome. The overall MCA asymmetry index was two-fold higher in CS patients with a poor outcome (10.26%) compared to those with a good outcome (5.41%, p = 0.002). In multivariable analysis, the overall MCA asymmetry index (OR, 1.054, 95% CI, 1.013-1.096, p = 0.009) and the cutoff value of the overall MCA asymmetry index >9 were associated with poor outcomes at 3 months (OR, 3.737, 95% CI, 1.530-9.128, p = 0.004). CONCLUSION We demonstrated that the novel asymmetric MCA index can predict short-term functional outcomes in CS patients.
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Jeong HT, Kim DS, Kang KW, Nam YT, Oh JE, Cho EK. Factors Affecting Basilar Artery Pulsatility Index on Transcranial Doppler. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2018. [DOI: 10.15324/kjcls.2018.50.4.477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ho Tae Jeong
- Department of Neurology, Chung-Ang University Hospital, Department of Medicine (Major in Neurology), Chung-Ang University Graduate School, Seoul, Korea
| | - Dae Sik Kim
- Department of Clinical Laboratory Science, Dongnam Health University, Suwon, Korea
| | - Kun Woo Kang
- Department of Neurology, Samsung Medical Center, Seoul, Korea
| | - Yun Teak Nam
- Department of Neurology, National Health Insurance Ilsan Hospitall, Goyang, Korea
| | - Ji Eun Oh
- Department of Biomedical Laboratory Science, Far East University, Eumseong, Korea
| | - Eun Kyung Cho
- Department of Clinical Laboratory Science, Dongnam Health University, Suwon, Korea
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de la Cruz-Cosme C, Dawid-Milner MS, Ojeda-Burgos G, Gallardo-Tur A, Segura T. Doppler Resistivity and Cerebral Small Vessel Disease: Hemodynamic Structural Correlation and Usefulness for the Etiological Classification of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:3425-3435. [PMID: 30185397 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND GOAL Lacunar stroke is defined as an <1.5 cm diameter infarct located in the territory of a perforating artery, that is not accessible for direct study using conventional imaging techniques. Diagnosis requires exclusion of other causes. It usually occurs in the context of chronic cerebral small vessel disease, which can be suspected during the neurosonography study in the form of high pulsatility [PI] or resistance index [RI]. Clinical research was performed to confirm that PI and RI correlate with cerebral small vessel lesion burden and to determine whether these parameters are useful for supporting a lacunar origin (LO) in acute stroke. MATERIAL AND METHODS We prospectively recorded internal carotid artery resistivity and the Fazekas score for all patients with acute ischemic stroke who met inclusion but not exclusion criteria over a 6-month period. RESULTS The study population comprised 74 patients. A correlation was observed between the Fazekas score and resistivity. Both parameters predicted a LO, with an area under the curve of .78 and .696, respectively. The optimal cut-offs were PI = .96/RI = .58 for screening (sensitivity, 96%) and PI = 1.46/RI = .83 for confirmation (specificity, 89%). CONCLUSIONS Doppler ultrasound is a useful technique for determining the LO of acute stroke.
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Affiliation(s)
| | - Marc Stefan Dawid-Milner
- Neurophysiology of the Autonomic Nervous System Unit, CIMES, Universidad de Málaga, Málaga, Spain
| | - Guillermo Ojeda-Burgos
- Internal Medicine Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain
| | - Alejandro Gallardo-Tur
- Neurology Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain; FIMABIS (Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud [Andalusian Public Research Foundation]), Málaga, Spain
| | - Tomás Segura
- Neurology Department, Hospital Universitario de Albacete (Albacete), Albacete, Spain
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Washio T, Sasaki H, Ogoh S. Acute impact of drinking coffee on the cerebral and systemic vasculature. Physiol Rep 2018; 5:e13288. [PMID: 28526782 PMCID: PMC5449567 DOI: 10.14814/phy2.13288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 01/09/2023] Open
Abstract
Previous studies have suggested that the risk of ischemic stroke increases immediately after drinking coffee. Indeed, drinking coffee, that is, caffeine, acutely increases arterial stiffness as well as blood pressure and peripheral vascular resistance. On the other hand, it has been reported that arterial stiffening is associated with elevation in the pulsatility index (PI) of cerebral blood flow (CBF), which increases the risk of brain disease. However, the effect of drinking coffee on the PI of the CBF and its interaction with arterial stiffness remain unknown. Against this background, we hypothesized that an acute increase in arterial stiffness induced by drinking coffee augments cerebral pulsatile stress. To test this hypothesis, in 10 healthy young men we examined the effects of drinking coffee on the PI of middle cerebral artery blood velocity (MCAv) and brachial‐ankle pulse wave velocity (baPWV) as indices of cerebral pulsatile stress and arterial stiffness, respectively. Mean arterial blood pressure and baPWV were higher (P < 0.01 and P = 0.02), whereas mean MCAV and mean cerebrovascular conductance index were lower upon drinking coffee (P = 0.02 and P < 0.01) compared with a placebo (decaffeinated coffee). However, there was no difference in the PI of MCAv between drinking coffee and the placebo condition. These findings suggest that drinking coffee does not increase cerebral pulsatile stress acutely despite an elevation in arterial stiffness in the systemic circulation.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Hiroyuki Sasaki
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan
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Central and cerebral haemodynamic changes after antihypertensive therapy in ischaemic stroke patients: A double-blind randomised trial. Sci Rep 2018; 8:1556. [PMID: 29367614 PMCID: PMC5784025 DOI: 10.1038/s41598-018-19998-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/10/2018] [Indexed: 11/23/2022] Open
Abstract
Central and cerebral haemodynamic parameters can vary under similar brachial blood pressure (BP). We aimed to investigate the effects of antihypertensive agents on central and cerebral haemodynamic parameters in hypertensive patients with ischaemic stroke. The Fimasartan, Atenolol, and Valsartan On haemodynamic paRameters (FAVOR) study was conducted in a prospective, double-blinded manner. One hundred five patients were randomly administered atenolol, valsartan, or fimasartan during 12 weeks. We measured brachial, central, cerebral haemodynamic parameters and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at baseline and after 12-week. Baseline haemodynamic parameters were balanced among the three groups. Even with similar brachial BP reduction, significantly lower central systolic BP (atenolol; 146.5 ± 18.8 vs. valsartan; 133.5 ± 20.7 vs. fimasartan; 133.6 ± 19.8 mmHg, p = 0.017) and augmentation index values (89.8 ± 13.2 vs. 80.6 ± 9.2 vs. 79.2 ± 11.6%; p = 0.001) were seen in the angiotensin receptor blockers (ARBs) groups. The pulsatility index on transcranial Doppler was significantly reduced in valsartan (p = 0.002) and fimasartan group (p = 0.008). Plasma NT-proBNP level was also significantly decreased in ARB groups, especially for the fimasartan group (37.8 ± 50.6 vs. 29.2 ± 36.9 vs.19.2 ± 27.8 pg/mL; p = 0.006). These findings suggest that short-term ARB administration would be favourable for ischaemic stroke patients with hypertension, permitting effective reduction of central pressure and dampening of cerebral pulsatility.
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González-Suárez I, Ríos-Blanco JJ, Arpa J. Accelerated atherosclerosis in ANCA-associated vasculitis. Acta Neurol Scand 2017; 136:688-693. [PMID: 28608454 DOI: 10.1111/ane.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Cardiovascular disease, including myocardial infarction and stroke, is a major cause of mortality in ANCA-associated vasculitis (AAV). Although AAV affects small vessels, an accelerated atherosclerosis not explained by traditional cardiovascular risk factors (CVRF) has been demonstrated. We aimed to investigate the association of atherosclerosis measured by carotid intima-media thickness (CIMT) and cerebral small vessel disease in AAV-patients. MATERIALS & METHODS Twenty-three AAV-patients in complete remission were recruited. Carotid ultrasonography (US), transcranial Doppler (TCD), brain magnetic resonance imaging (MRI), and SPECT after intravenous administration of tracer 99mTc-HMPAO (dose: 720MBq) were performed. RESULTS AAV-patients presented higher CIMT compared to normative population. Multivariate linear regression analysis demonstrated an association of higher CIMT with increased pulsatility index in middle cerebral artery (PI-MCA) (P=.011), higher lesion load on ARWMC scale (P=.011) and abnormal SPECT (P=.008). No association between higher CIMT and CVRF (diabetes or hypertension) was demonstrated. Increasing internal carotid artery pulsatility index (PI-ICA) was associated with decreasing mean flow velocity (MFV)-MCA (P=.038), increasing PI-MCA (P=.008) and increasing white matter lesions on MRI (P=.011). CONCLUSIONS Our study adds weight to the presence of increased atherosclerosis in AAV-patients. The association observed between CIMT and PI-ICA with small vessel cerebral disease, points the possible association of easy to use carotid US in predicting microvascular brain injury.
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Affiliation(s)
| | - J. J. Ríos-Blanco
- Internal Medicine Department; Hospital Universitario La Paz; Madrid Spain
| | - J. Arpa
- Neurology Department; Hospital Clínico San Carlos; Madrid Spain
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Schnerr RS, Jansen JFA, Uludag K, Hofman PAM, Wildberger JE, van Oostenbrugge RJ, Backes WH. Pulsatility of Lenticulostriate Arteries Assessed by 7 Tesla Flow MRI-Measurement, Reproducibility, and Applicability to Aging Effect. Front Physiol 2017; 8:961. [PMID: 29225580 PMCID: PMC5705621 DOI: 10.3389/fphys.2017.00961] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/10/2017] [Indexed: 01/26/2023] Open
Abstract
Characterization of flow properties in cerebral arteries with 1.5 and 3 Tesla MRI is usually limited to large cerebral arteries and difficult to evaluate in the small perforating arteries due to insufficient spatial resolution. In this study, we assessed the feasibility to measure blood flow waveforms in the small lenticulostriate arteries with 7 Tesla velocity-sensitive MRI. The middle cerebral artery was included as reference. Imaging was performed in five young and five old healthy volunteers. Flow was calculated by integrating time-varying velocity values over the vascular cross-section. MRI acquisitions were performed twice in each subject to determine reproducibility. From the flow waveforms, the pulsatility index and damping factor were deduced. Reproducibility values, in terms of the intraclass correlation coefficients, were found to be good to excellent. Measured pulsatility index of the lenticulostriate arteries significantly increased and damping factor significantly decreased with age. In conclusion, we demonstrate that blood flow through the lenticostriate arteries can be precisely measured using 7 Tesla MRI and reveal effects of arterial stiffness due to aging. These findings hold promise to provide relevant insights into the pathologies involving perforating cerebral arteries.
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Affiliation(s)
- Roald S Schnerr
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kamil Uludag
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Paul A M Hofman
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Robert J van Oostenbrugge
- Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Hitsumoto T. Impact of Hemorheology Assessed by the Microchannel Method on Pulsatility Index of the Common Carotid Artery in Patients With Type 2 Diabetes Mellitus. J Clin Med Res 2017; 9:579-585. [PMID: 28611858 PMCID: PMC5458655 DOI: 10.14740/jocmr3031w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/11/2022] Open
Abstract
Background Type 2 diabetes mellitus is known to be closely associated with the risk of ischemic stroke. Recent clinical studies have reported that a high pulsatility index (PI) of the cerebral or carotid artery, which is estimated by ultrasonography, also reflects a risk of ischemic stroke. This cross-sectional study aimed to clarify the impact of hemorheology assessed by the microchannel method on the PI of the common carotid artery (CCA) in patients with type 2 diabetes mellitus in terms of the primary prevention of ischemic stroke. Methods In total, 349 outpatients on treatment for type 2 diabetes mellitus (131 men and 218 women; mean age ± standard deviation: 65 ± 11 years) with no history of cardiovascular events, including ischemic stroke, were enrolled. The whole blood passage time (WBPT) as a marker of hemorheology and the PI of CCA were measured using commercial devices, and their relationships to various clinical parameters were examined. Results A significant positive correlation was observed between WBPT and the PI of CCA (r = 0.49, P < 0.001). Furthermore, multivariate analysis revealed that patients with high WBPT (≥70 s) had significantly higher risk (odds ratio: 5.2; 95% confidence interval: 2.4 - 9.2; P < 0.001) of being detected with a high PI of CCA (≥ 2) than those with low WBPT (≤ 52.0 s). Conclusion The results of this study indicated that WBPT was an important determination factor for the PI of CCA, suggesting that an increase in WBPT can potentially predict the incidence of ischemic stroke in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Takashi Hitsumoto
- Hitsumoto Medical Clinic, 2-7-7, Takezakicyou, Shimonoseki City, Yamaguchi 750-0025, Japan.
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Effects of Reynolds and Womersley Numbers on the Hemodynamics of Intracranial Aneurysms. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:7412926. [PMID: 27847544 PMCID: PMC5101408 DOI: 10.1155/2016/7412926] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/29/2016] [Accepted: 08/10/2016] [Indexed: 11/17/2022]
Abstract
The effects of Reynolds and Womersley numbers on the hemodynamics of two simplified intracranial aneurysms (IAs), that is, sidewall and bifurcation IAs, and a patient-specific IA are investigated using computational fluid dynamics. For this purpose, we carried out three numerical experiments for each IA with various Reynolds (Re = 145.45 to 378.79) and Womersley (Wo = 7.4 to 9.96) numbers. Although the dominant flow feature, which is the vortex ring formation, is similar for all test cases here, the propagation of the vortex ring is controlled by both Re and Wo in both simplified IAs (bifurcation and sidewall) and the patient-specific IA. The location of the vortex ring in all tested IAs is shown to be proportional to Re/Wo2 which is in agreement with empirical formulations for the location of a vortex ring in a tank. In sidewall IAs, the oscillatory shear index is shown to increase with Wo and 1/Re because the vortex reached the distal wall later in the cycle (higher resident time). However, this trend was not observed in the bifurcation IA because the stresses were dominated by particle trapping structures, which were absent at low Re = 151.51 in contrast to higher Re = 378.79.
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Maseroli E, Fanni E, Cipriani S, Scavello I, Pampaloni F, Battaglia C, Fambrini M, Mannucci E, Jannini EA, Maggi M, Vignozzi L. Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance. J Sex Med 2016; 13:1651-1661. [PMID: 27692844 DOI: 10.1016/j.jsxm.2016.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. AIM To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. METHODS Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. MAIN OUTCOME MEASURES Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). RESULTS Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = -0.321, P = .014) and satisfaction (β = -0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast). CONCLUSION Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.
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Affiliation(s)
- Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Egidia Fanni
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sarah Cipriani
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Irene Scavello
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Pampaloni
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Cesare Battaglia
- Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy
| | - Massimiliano Fambrini
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Edoardo Mannucci
- Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy
| | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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Sanahuja J, Alonso N, Diez J, Ortega E, Rubinat E, Traveset A, Alcubierre N, Betriu À, Castelblanco E, Hernández M, Purroy F, Arcidiacono MV, Jurjo C, Fernández E, Puig-Domingo M, Groop PH, Mauricio D. Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy. Diabetes Care 2016; 39:1614-20. [PMID: 27281772 DOI: 10.2337/dc15-2671] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/18/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to examine the presence and severity of brain small vessel disease (SVD) in patients with type 2 diabetes and diabetic retinopathy (DR) compared with those without DR. RESEARCH DESIGN AND METHODS We evaluated 312 patients with type 2 diabetes without previous cardiovascular disease (men 51%; mean age 57 years; age range 40-75 years); 153 patients (49%) had DR. MRI was performed to evaluate the presence and severity (age-related white matter changes scale) of white matter lesions (WMLs) and lacunes, and transcranial Doppler ultrasound was used to measure the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTS The prevalence of lesions of cerebral SVD (WML and/or lacunes) was higher in patients with DR (40.2% vs. 30.1% without DR, P = 0.04). Age (P < 0.01) and systolic blood pressure (P = 0.02) were associated with the presence of SVD. The severity of SVD was associated with age and the presence of DR (P < 0.01 and P = 0.01, respectively). Patients with DR showed a higher MCA PI compared with those without DR (P < 0.01). Age, systolic and diastolic blood pressure, and retinopathy and its severity were associated with an increased MCA PI (P < 0.01 for all variables). A positive correlation was found between MCA PI values and the presence and severity of SVD (P < 0.01 for both variables). CONCLUSIONS Patients with type 2 diabetes who have DR have an increased burden of cerebral SVD compared with those without DR. Our findings suggest that the brain is a target organ for microangiopathy, similar to other classic target organs, like the retina.
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Affiliation(s)
- Jordi Sanahuja
- Department of Neurology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Javier Diez
- Institut de Diagnòstic per la Imatge, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Emilio Ortega
- Institut de Recerca Biomedica de Lleida, University of Lleida, Lleida, Spain
| | - Esther Rubinat
- Department of Endocrinology & Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, Centro de Investigación Biomédica en Red de la Obesidad y la Nutrición, Hospital Clinic, Barcelona, Spain
| | - Alícia Traveset
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Núria Alcubierre
- Department of Endocrinology & Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, Centro de Investigación Biomédica en Red de la Obesidad y la Nutrición, Hospital Clinic, Barcelona, Spain
| | - Àngels Betriu
- Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Francisco Purroy
- Department of Neurology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Maria Vittoria Arcidiacono
- Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Carmen Jurjo
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Elvira Fernández
- Department of Endocrinology & Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, Centro de Investigación Biomédica en Red de la Obesidad y la Nutrición, Hospital Clinic, Barcelona, Spain Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, University Hospital Arnau de Vilanova, Lleida, Spain Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Manuel Puig-Domingo
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Per-Henrik Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; and Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Health Science Research Institute and University Hospital, Badalona, Spain CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Kim Y, Lee H, An SA, Yim B, Kim J, Kim OJ, Kim WC, Kim HS, Oh SH, Kim J. The Effect of Pulsatility Index on Infarct Volume in Acute Lacunar Stroke. Yonsei Med J 2016; 57:950-5. [PMID: 27189290 PMCID: PMC4951473 DOI: 10.3349/ymj.2016.57.4.950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/12/2015] [Accepted: 11/17/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Lacunar stroke, in the context of small vessel disease, is a type of cerebral infarction caused by occlusion of a penetrating artery. Pulsatility index (PI) is an easily measurable parameter in Transcranial Doppler ultrasound (TCD) study. PI reflects distal cerebral vascular resistance and has been interpreted as a surrogate marker of small vessel disease. We hypothesized that an increased PI, a marker of small vessel disease, might be associated with a larger infarct volume in acute lacunar stroke. MATERIALS AND METHODS This study included 64 patients with acute lacunar stroke who underwent TCD and brain MRI. We evaluated the association between the mean PI value of bilateral middle cerebral arteries and infarct volume on diffusion-weighted MRI using univariate and multivariate linear regression. RESULTS The mean infarct volume and PI were 482.18±406.40 mm³ and 0.86±0.18, respectively. On univariate linear regression, there was a significant positive association between PI and infarct volume (p=0.001). In the multivariate model, a single standard deviation increase of PI (per 0.18) was associated with an increase of 139.05 mm³ in infarct volume (95% confidence interval, 21.25 to 256.85; p=0.022). CONCLUSION We demonstrated that PI was an independent determinant of infarct volume in acute lacunar stroke. The PI value measured in acute stroke may be a surrogate marker of the extent of ischemic injury.
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Affiliation(s)
- Yoon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hanbin Lee
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Se A An
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Byeongsoo Yim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jonguk Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ok Joon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won Chan Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyun Sook Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seung Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Telman G, Kouperberg E, Sprecher E, Gruberg L, Beyar R, Yarnitsky D. TCD Evaluation before and after Stenting in Patients with Severe Primary Carotid Artery Stenosis versus Restenosis. J Endovasc Ther 2016; 14:483-8. [PMID: 17696622 DOI: 10.1177/152660280701400408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate cerebral hemodynamics before and after carotid angioplasty and stenting (CAS) using transcranial Doppler (TCD). Methods: Sixty-eight patients (52 men; mean age 69±9.5 years) with severe carotid stenosis (83.4%±10.2%) were examined by TCD before and 2 months after CAS. Thirty-two (47%) patients had primary carotid stenosis and 36 (53%) had restenosis after carotid endarterectomy (CEA). A broad TCD protocol was employed to estimate cerebral hemodynamics, including assessment of velocities (V) and asymmetry of cerebral blood flow velocity (CBFV) in the middle cerebral artery, (MCA) anterior cerebral artery (ACA), and basilar artery (BA); the pulsatility indexes; and flow acceleration. Results: Ipsilateral MCA mean velocities before stenting were 46.3±12.6 cm/s in the primary stenosis group and 47.1±12.3 cm/s in restenosis group; after stenting, the velocities were 53.8±12.1 and 52.7±9.6 cm/s, respectively (p<0.005 for both groups). MCA asymmetry by Vmean before CAS was higher in the primary stenosis group (27.6%±2.4% versus 19.8%±2.3%, p<0.05). After stenting, this index was significantly lower in both groups: 16.4%±2.4% and 12.3%±2.3%, respectively (p<0.0001 for each group). All other TCD parameters improved significantly in both groups after CAS as well (p<0.05), showing the strong hemodynamic effect of this procedure. Conclusion: CAS effectively improves cerebral hemodynamics in patients with severe primary and restenosis of the internal carotid artery.
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Affiliation(s)
- Gregory Telman
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
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Wu JF, Wang HJ, Wu Y, Li F, Bai YL, Zhang PY, Chan CCH. Efficacy of transcranial alternating current stimulation over bilateral mastoids (tACS bm) on enhancing recovery of subacute post-stroke patients. Top Stroke Rehabil 2016; 23:420-429. [PMID: 27145292 DOI: 10.1080/10749357.2016.1175218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Transcranial alternating current stimulation (tACS) offers another method of non-invasive brain stimulation in post-stroke rehabilitation. Because it is not known if tACS over bilateral mastoids (tACSbm) can promote the functional recovery in subacute post-stroke patients, we wish to learn the effect of tACSbm on improving neurological function and intracranial hemodynamics of subacute post-stroke patients. METHODS Sixty subacute post-stroke patients (mean age: 65.4 ± 9.8 years), 15 to 60 days after the onset, were randomly assigned to receiving 15 sessions of usual rehabilitation program without (n = 30) or with tACSbm (20 Hz and < 400 μA for 30-min; n = 30). The outcome measures included the NIH Stroke Scale (NIHSS) and measures of intracranial hemodynamics before and after treatment. RESULTS At the fifteenth session, when compared with the baseline, the mean NIHSS scores of the patients in the tACSbm group had significantly a larger decrease [18.3 ± 2.6 vs. 10.8 ± 2.7; p < 0.001] than that of the control group [19.1 ± 2.7 vs. 13.0 ± 2.4] [F(1,54) = 4.29, p = 0.043]. After both the first and fifteenth sessions, compared with the control group, the mean blood flow velocity (MFVs) of the tACSbm group had significantly larger increase in the MCA, ACA, and PCA (p < 0.001), the Gosling pulsatility index (PI) of the tACSbm group had also significantly larger decline in the MCA, ACA, and PCA than that of the control group (p < 0.001). The best predictor of the changes in the NIHSS scores was the decline in the pulsatility index in the vascular territory of both lesional and non-lesional MCA measured by the end of the last treatment session. CONCLUSIONS tACSbm appeared to be effective for enhancing patients' functional recovery and cerebral hemodynamics in the subacute phase. The extent of recovery seems to be associated with the decline of the resistance in vascular bed of the main cerebral arteries. The mechanisms behind this effect should be explored further through research.
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Affiliation(s)
- Jun-Fa Wu
- a Department of Rehabilitation Medicine, Huashan Hospital , Fudan University , Shanghai , China
| | - Hai-Jue Wang
- a Department of Rehabilitation Medicine, Huashan Hospital , Fudan University , Shanghai , China
| | - Yi Wu
- a Department of Rehabilitation Medicine, Huashan Hospital , Fudan University , Shanghai , China.,b State Key Laboratory of Medical Neurobiology , Fudan University , Shanghai , China
| | - Fang Li
- a Department of Rehabilitation Medicine, Huashan Hospital , Fudan University , Shanghai , China
| | - Yu-Long Bai
- a Department of Rehabilitation Medicine, Huashan Hospital , Fudan University , Shanghai , China
| | - Peng-Yu Zhang
- a Department of Rehabilitation Medicine, Huashan Hospital , Fudan University , Shanghai , China
| | - Chetwyn C H Chan
- c Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences , The Hong Kong Polytechnic University , Hong Kong , China
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Webb AJS, Rothwell PM. Magnetic Resonance Imaging Measurement of Transmission of Arterial Pulsation to the Brain on Propranolol Versus Amlodipine. Stroke 2016; 47:1669-72. [PMID: 27143273 DOI: 10.1161/strokeaha.115.012411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral arterial pulsatility is associated with leukoaraiosis and depends on central arterial pulsatility and arterial stiffness. The effect of antihypertensive drugs on transmission of central arterial pulsatility to the cerebral circulation is unknown, partly because of limited methods of assessment. METHODS In a technique-development pilot study, 10 healthy volunteers were randomized to crossover treatment with amlodipine and propranolol. At baseline and on each drug, we assessed aortic (Sphygmocor) and middle cerebral artery pulsatility (TCDtranscranial ultrasound). We also performed whole-brain, 3-tesla multiband blood-oxygen level dependent magnetic resonance imaging (multiband factor 6, repetition time=0.43s), concurrent with a novel method of continuous noninvasive blood pressure monitoring. Drug effects on relationships between cardiac cycle variation in blood pressure and blood-oxygen level dependent imaging were determined (fMRI Expert Analysis Tool, fMRIB Software Library [FEAT-FSL]). RESULTS Aortic pulsatility was similar on amlodipine (27.3 mm Hg) and propranolol (27.9 mm Hg, P diff=0.33), while MCA pulsatility increased nonsignificantly more from baseline on propranolol (+6%; P=0.09) than amlodipine (+1.5%; P=0.58). On magnetic resonance imaging, cardiac frequency blood pressure variations were found to be significantly more strongly associated with blood-oxygen level dependent imaging on propranolol than amlodipine. CONCLUSIONS We piloted a novel method of assessment of arterial pulsatility with concurrent high-frequency blood-oxygen level dependent magnetic resonance imaging and noninvasive blood pressure monitoring. This method was able to identify greater transmission of aortic pulsation on propranolol than amlodipine, which warrants further investigation.
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Affiliation(s)
- Alastair J S Webb
- From the Stroke Prevention Research Unit (SPRU), John Radcliffe Hospital, Oxford, United Kingdom.
| | - Peter M Rothwell
- From the Stroke Prevention Research Unit (SPRU), John Radcliffe Hospital, Oxford, United Kingdom
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Rathod KS, Jones DA, Bromage DI, Gallagher SM, Rathod VS, Kennon S, Knight C, Rothman MT, Mathur A, Smith E, Jain AK, Archbold RA, Wragg A. Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients. J Cardiovasc Med (Hagerstown) 2016; 16:170-7. [PMID: 25634086 DOI: 10.2459/jcm.0000000000000230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To compare long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) using radial and femoral arterial access. METHODS AND RESULTS The present study was an observational cohort study of patients with STEMI treated consecutively with PPCI between 2004 and 2011 at a single centre. The primary end point was all-cause mortality at a median follow-up of 3 years.Among 2727 patients, 1600 (58.7%) underwent PPCI via the femoral route. The femoral group was older (64.7 vs. 61.7 years; P < 0.0001), and had higher rates of diabetes (18.6% vs. 16.0%; P < 0.0001), previous PCI (11.2 vs. 7.8%; P = 0.004), previous myocardial infarction (15.3 vs. 8.3%; P < 0.0001) and cardiogenic shock (9.8 vs. 1.3%; P < 0.0001). Bleeding complications were more frequent in the femoral group (4.7 vs. 1.2%; P < 0.0001). The 5-year death rate was significantly higher in the femoral group than in the radial group (10.4 vs. 3.0%; P < 0.0001). After adjustment for confounding variables, bleeding complications [heart rate 2.07 (95% confidence interval 1.05-4.08)] and femoral access [heart rate 1.60 (95% confidence interval 1.02-2.53)] were independent predictors of all-cause mortality. After stratification using the propensity score, excess long-term mortality in patients treated via the femoral approach was predominantly in patients with a high baseline risk of death. CONCLUSION Patients undergoing PPCI via the femoral route are at a higher risk of adverse short-term and long-term outcomes than patients undergoing PPCI via the radial route. Patients with a high baseline risk may benefit most from radial access, and future outcome studies should focus on the most at-risk patients.
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Affiliation(s)
- Krishnaraj S Rathod
- aDepartment of Cardiology, London Chest Hospital bDepartment of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University cNIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
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43
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Altmann M, Thommessen B, Rønning OM, Benth JŠ, Reichenbach AS, Fure B. Middle Cerebral Artery Pulsatility Index is Associated with Cognitive Impairment in Lacunar Stroke. J Neuroimaging 2016; 26:431-5. [PMID: 26800090 DOI: 10.1111/jon.12335] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/25/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Pulsatility index (PI) of the middle cerebral artery is postulated to reflect the vascular resistance in the artery distal of the probe, and has been reported to increase in small vessel disease, diabetes mellitus, ageing, and dementia. Lacunar infarcts are considered to be related to cognitive impairment. We therefore conducted a study to assess the association between cognitive impairment and PI in patients with a lacunar infarct. METHODS Consecutive patients presenting with an acute lacunar syndrome who were admitted to the stroke unit were enrolled. The patients were examined with Doppler ultrasonography of the intracranial arteries, and the PI of the middle cerebral artery was recorded. Cognitive function was evaluated by mini-mental state examination (MMSE), clock drawing test, and trail making test (TMT) A and B. RESULTS Among the 113 patients included, 85 patients had an acute lacunar infarct and 28 had one or more nonlacunar infarcts. The mean PI was 1.46 (SD = .33). PI was significantly (P < .05) associated with MMSE, TMT A and TMT B in patients with lacunar infarct, even after adjustment for multiple patient characteristics (age, sex, prestroke hypertension, smoking, previous stroke, and diabetes). CONCLUSIONS PI was associated with the cognitive performance in patients with lacunar infarcts and a lacunar syndrome. An elevated PI may be related to impairment in several cognitive domains. These findings suggest that transcranial Doppler ultrasonography could be an adjunct tool for early diagnosis of cognitive impairment after stroke.
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Affiliation(s)
- Marianne Altmann
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus AHUS, University of Oslo, Norway
| | - Bente Thommessen
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway
| | - Ole Morten Rønning
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus AHUS, University of Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus AHUS, University of Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Norway
| | - Antje S Reichenbach
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway
| | - Brynjar Fure
- Specialist Health Section, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Brar I, Robertson AD, Hughson RL. Increased central arterial stiffness and altered cerebrovascular haemodynamic properties in South Asian older adults. J Hum Hypertens 2015; 30:309-14. [PMID: 26178590 DOI: 10.1038/jhh.2015.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/25/2015] [Accepted: 06/04/2015] [Indexed: 01/22/2023]
Abstract
South Asians (SA) suffer from a higher burden of heart disease and stroke compared with White Caucasians (CA). We hypothesized that increased arterial stiffness in older adults of SA origin would be associated with greater cerebrovascular pulsatile pressure and flow characteristics compared with CA older adults. Forty-four SA and CA older adults, free of known cardiovascular and cerebrovascular diseases, were assessed. Vascular ageing was characterized by brachial-ankle pulse wave velocity, carotid pulse pressure, compliance coefficient (CC) and intima-media thickness (IMT). Duplex ultrasonography of the internal carotid arteries estimated anterior cerebral blood flow (aCBF) and cerebrovascular resistance (aCVR), and transcranial Doppler ultrasound quantified middle cerebral artery blood flow velocity, resistive index (RI) and pulsatility index (PI). Fasting blood samples were collected to assess glycaemic status, lipid profile and C-reactive protein. SA had higher carotid pulse pressure and lower CC indicating stiffer arteries compared with CA. Multiple regression analyses revealed that ethnic differences in arterial stiffness were associated with glycated haemoglobin level in SA. Among SA, an inverse association was observed between carotid CC and aCVR. In turn, aCVR was associated with a steeper reduction in aCBF in SA than in CA. IMT was strongly associated with greater PI and RI (r>0.81, P<0.001) in SA, whereas a weaker relationship for PI (r=0.46, P=0.03) and no significant relationship for RI were found in CA. The study found stronger associations between pulsatile cerebrovascular haemodynamics and structural and functional alterations in central arteries in SA that may underlie the elevated risk for cerebrovascular disease.
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Affiliation(s)
- I Brar
- Faculty of Applied Health Sciences, Schlegel-University of Waterloo Research Institute for Aging, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - A D Robertson
- Faculty of Applied Health Sciences, Schlegel-University of Waterloo Research Institute for Aging, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - R L Hughson
- Faculty of Applied Health Sciences, Schlegel-University of Waterloo Research Institute for Aging, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Vlad D, Popescu R, Velciov S, Gluhovschi C, Bob F, Ursoniu S, Petrica M, Jianu DC. Glycated peptides are associated with the variability of endothelial dysfunction in the cerebral vessels and the kidney in type 2 diabetes mellitus patients: a cross-sectional study. J Diabetes Complications 2015; 29:230-7. [PMID: 25511877 DOI: 10.1016/j.jdiacomp.2014.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diabetic atherosclerosis and microangiopathy parallel diabetic nephropathy. The aim of our study was to evaluate the pattern of endothelial dysfunction in two vascular territories, the kidney and the brain, both affected by diabetic vasculopathic complications. The endothelial variability was evaluated in relation to advanced glycation end-products modified peptides. METHODS Seventy patients with type 2 diabetes mellitus and 11 healthy subjects were assessed concerning urine albumin: creatinine ratio, plasma and urinary advanced glycation end-products, plasma asymmetric dimethyl-arginine, serum cystatin C, intima-media thickness in the common carotid arteries, the pulsatility index, the resistance index in the internal carotid arteries and the middle cerebral arteries, the cerebrovascular reactivity through the breath-holding test. RESULTS The breath-holding index correlated with asymmetric dimethyl-arginine (R²=0.151; p<0.001), plasma advanced glycation end-products (R²=0.173; p<0.001), C-reactive protein (R²=0.587; p<0.001), duration of diabetes mellitus (R²=0.146; p=0.001), cystatin C (R²=0.220; p<0.001), estimated glomerular filtration rate (R²=0.237; p=0.001). Urine albumin: creatinine ratio correlated with urinary advanced glycation end-products (R²=0.257; p<0.001), but not with asymmetric dimethyl-arginine (R²=0.029; p=0.147). CONCLUSIONS In type 2 diabetic patients endothelial dysfunction in the cerebral vessels appears to be dissociated from glomerular endothelial dysfunction in early diabetic nephropathy. Advanced glycation end-products could impact both the cerebral vessels and the glomerular endothelium.
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MESH Headings
- Aged
- Albuminuria/etiology
- Arginine/analogs & derivatives
- Arginine/blood
- Biomarkers/blood
- Biomarkers/urine
- Breath Holding
- Cohort Studies
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2/complications
- Diabetic Angiopathies/blood
- Diabetic Angiopathies/metabolism
- Diabetic Angiopathies/physiopathology
- Diabetic Angiopathies/urine
- Diabetic Nephropathies/blood
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/physiopathology
- Diabetic Nephropathies/urine
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Female
- Glomerular Filtration Rate
- Glycation End Products, Advanced/blood
- Glycation End Products, Advanced/metabolism
- Glycation End Products, Advanced/urine
- Humans
- Kidney/blood supply
- Kidney/metabolism
- Kidney/physiopathology
- Male
- Middle Aged
- Outpatient Clinics, Hospital
- Romania
- Severity of Illness Index
- Vasculitis, Central Nervous System/complications
- Vasculitis, Central Nervous System/metabolism
- Vasculitis, Central Nervous System/physiopathology
- Vasculitis, Central Nervous System/urine
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Affiliation(s)
- Ligia Petrica
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Adrian Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Diabetes and Metabolic Diseases, County Emergency Hospital, Timisoara, Romania.
| | - Gheorghe Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Florica Gadalean
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Victor Dumitrascu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Daliborca Vlad
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Pharmacology, County Emergency Hospital, Clinical Laboratory, Timisoara, Romania.
| | - Roxana Popescu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Clinical Laboratory, Department of Cellular Biology, County Emergency Hospital, Timisoara, Romania.
| | - Silvia Velciov
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Cristina Gluhovschi
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Flaviu Bob
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Nephrology, County Emergency Hospital, Timisoara, Romania.
| | - Sorin Ursoniu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Public Health Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
| | - Maxim Petrica
- Department of Neurology, County Emergency Hospital, Timisoara, Romania.
| | - Dragos Catalin Jianu
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Neurology, County Emergency Hospital, Timisoara, Romania.
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Schubert T, Pansini M, Bieri O, Stippich C, Wetzel S, Schaedelin S, von Hessling A, Santini F. Attenuation of blood flow pulsatility along the Atlas slope: a physiologic property of the distal vertebral artery? AJNR Am J Neuroradiol 2015; 36:562-7. [PMID: 25395658 DOI: 10.3174/ajnr.a4148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Physiologic and pathologic arterial tortuosity may attenuate blood flow pulsatility. The aim of this prospective study was to assess a potential effect of the curved V3 segment (Atlas slope) of the vertebral artery on arterial flow pulsatility. The pulsatility index and resistance index were used to assess blood flow pulsatility. MATERIALS AND METHODS Twenty-one healthy volunteers (17 men, 4 women; mean age, 32 years) were examined with a 3T MR imaging system. Blood velocities were measured at 2 locations below (I and II) and at 1 location above the V3 segment (III) of the vertebral artery by using a high-resolution 2D-phase-contrast sequence with multidirectional velocity-encoding. RESULTS Pulsatility and resistance indices decreased along all measurement locations from proximal to distal. The pulsatility index decreased significantly from location II to III and from I to II. However, the decrease was more pronounced along the Atlas slope than in the straight-vessel section below. The decrease of the resistance index was highly significant along the Atlas slope (location II to III). The decrease from location I to II was small and not significant. CONCLUSIONS The pronounced decrease in pulsatility and resistance indices along the interindividually uniformly bent V3 segment compared with a straight segment of the vertebral artery indicates a physiologic attenuating effect of the Atlas slope on arterial flow pulsatility. A similar effect has been described for the carotid siphon. A physiologic reduction of pulsatility in brain-supplying arteries would be in accordance with several recent publications reporting a correlation of increased arterial flow pulsatility with leukoencephalopathy and lacunar stroke.
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Affiliation(s)
- T Schubert
- From the Divisions of Neuroradiology (T.S., C.S., A.v.H.)
| | - M Pansini
- Department of Radiology (M.P.), Bruderholz Cantonal Hospital, Basel, Switzerland
| | - O Bieri
- Radiological Physics (O.B., F.S.), Clinic of Radiology and Nuclear Medicine
| | - C Stippich
- From the Divisions of Neuroradiology (T.S., C.S., A.v.H.)
| | - S Wetzel
- Department of Neuroradiology (S.W.), Hirslanden Clinic, Zurich, Switzerland
| | - S Schaedelin
- Clinical Trial Unit (S.S.), Basel University Hospital, Basel, Switzerland
| | - A von Hessling
- From the Divisions of Neuroradiology (T.S., C.S., A.v.H.)
| | - F Santini
- Radiological Physics (O.B., F.S.), Clinic of Radiology and Nuclear Medicine
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Ghorbani A, Ahmadi MJ, Shemshaki H. The value of transcranial Doppler derived pulsatility index for diagnosing cerebral small-vessel disease. Adv Biomed Res 2015; 4:54. [PMID: 25802823 PMCID: PMC4361964 DOI: 10.4103/2277-9175.151574] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 08/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background: The pulsatility index (PI), measured by transcranial Doppler (TCD) ultrasonography, can reflect vascular resistance induced by cerebral small-vessel disease (SVD). We evaluated the value of TCD-derived PI for diagnosing SVD as compared with magnetic resonance imaging (MRI). Materials and Methods: Fifty-six consecutive cases with SVD (based on MRI) and 48 controls with normal MRI underwent TCD. Based on MRI findings, patients were categorized into five subgroups of preventricular hyperintensity (PVH), deep white matter hyperintensity (DWMH), lacunar, pontin hyperintensity (PH), and PVH+DWMH+lacunar. The sensitivity and specificity of TCD in best PI cut-off points were calculated in each group. Results: The sensitivity and specificity of TCD in comparison with MRI with best PI cut-off points were as follows: In PVH with PI = 0.83, the sensitivity and specificity was 90% and 98%, respectively. In DWMH with PI = 0.79, the sensitivity and specificity was 75% and 87.5%, respectively. In lacunar with PI = 0.80, the sensitivity and specificity was 73% and 90%, respectively. In PH with PI = 0.69, the sensitivity and specificity was 92% and 87.5%, respectively. And, in PVH+DWMH+lacunar subgroup with PI = 0.83, the sensitivity and specificity was 90% and 96%, respectively. Conclusions: Increased TCD derived PI can accurately indicate the SVD. Hence, TCD can be used as a non-invasive and inexpensive method for diagnosing SVD, and TCD-derived PI can be considered as a physiologic index of the disease as well.
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Affiliation(s)
- Abbas Ghorbani
- Department of Neurology, Isfahan Neuroscience Research Center, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Javad Ahmadi
- Department of Neurology, Isfahan Neuroscience Research Center, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Shemshaki
- Department of Neurology, Isfahan Neuroscience Research Center, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim JY, Bushnell CD, Park JH, Han SM, Im JH, Han SW, Baik JS, Park JH. Central aortic pressure and pulsatility index in acute ischemic stroke. J Neuroimaging 2014; 25:438-42. [PMID: 25060557 DOI: 10.1111/jon.12151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/26/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE We investigated the relationship between transcranial Doppler (TCD) pulsatility index (PI) and central aortic pressure by measurement of the aortic augmentation index (AIx). METHODS We enrolled 148 consecutive patients with a diagnosis of acute ischemic stroke. Patients were eligible for the study if they experienced their first ischemic stroke within the preceding 7 days and were 45 years of age or older. At Day 7 (±2) after stroke onset, TCD studies were performed and AIx was measured by applanation tonometry on the same days. RESULTS The mean age was 66.3 (47-90) years and 37.8% were women. The mean middle cerebral artery (MCA) PI was significantly related with age (r =.361), hypertension (r = .184), peripheral systolic blood pressure (SBP; r = .211), peripheral pulse pressure (PP; r = .396), aortic SBP (r = .184), aortic DBP (r = -.181), and aortic PP (r = .371). The basilar artery (BA) PI was significantly related with age (r = .311), peripheral DBP (r = -.267), peripheral PP (r = .358), aortic DBP (r = -.266), and aortic PP (r = .347). CONCLUSIONS TCD PI was significantly related with central aortic pressure, especially PP. The PI in the MCA and BA is closely associated with the pulsatile component of BP in the systemic circulation.
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Affiliation(s)
- Jeong Yeon Kim
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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49
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Large artery stiffness and carotid flow pulsatility in stroke survivors. J Hypertens 2014; 32:1097-103; discussion 1103. [DOI: 10.1097/hjh.0000000000000137] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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50
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Bal S, Goyal M, Smith E, Demchuk AM. Central nervous system imaging in diabetic cerebrovascular diseases and white matter hyperintensities. HANDBOOK OF CLINICAL NEUROLOGY 2014; 126:291-315. [PMID: 25410230 DOI: 10.1016/b978-0-444-53480-4.00021-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus is an important vascular risk factor for cerebrovascular disease. This occurs through pathophysiologic changes to the microcirculation as arteriolosclerosis and to the macrocirculation as large artery atherosclerosis. Imaging techniques can provide detailed visualization of the cerebrovasculature using CT (computed tomography) angiography and MR (magnetic resonance) angiography. Newer techniques focused on advanced parenchymal imaging include CT perfusion, quantitative MRI, and diffusion tensor imaging; each identifies brain lesion burden due to diabetes mellitus. These imaging approaches have provided insights into the diabetes mellitus brain and cerebral circulation pathophysiology. Imaging has taught us that diabetics develop cerebral atrophy, silent infarcts, and white matter disease more rapidly than other patient populations. Longitudinal studies are needed to quantify the rate and extent of such structural brain and blood vessel changes and how they relate to cognitive decline. Diabetes prevention and treatment strategies will then be possible to slow the development of such changes.
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Affiliation(s)
- Simerpreet Bal
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Eric Smith
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada.
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