Ann Clin Neurophysiol.  2018 Jul;20(2):79-84. 10.14253/acn.2018.20.2.79.

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

• Lee SH
• Kim Y
• Lee Y
• Lee JH

• KMID: 2454709
• DOI: http://doi.org/10.14253/acn.2018.20.2.79

Abstract

BACKGROUND
Pulsatility of cerebral arteries and aortic stiffness have been associated with white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct.
METHODS
We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate-to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis.
RESULTS
Eighty-three patients (56 males, mean age 61.5 ± 11.4) participated in the study. Univariate analysis showed old age and high PI-MCA were significantly correlated with moderate-to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719.
CONCLUSIONS
PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.

Keyword

Pulsatility index; Aortic stiffness; Transcranial Doppler ultrasonography

MeSH Terms

Ankle
Ankle Brachial Index
Atrial Fibrillation
Cerebral Arteries
Cerebral Small Vessel Diseases
Constriction, Pathologic
Humans
Logistic Models
Magnetic Resonance Angiography
Male
Middle Cerebral Artery*
Multivariate Analysis
Pulse Wave Analysis
Stroke, Lacunar
Ultrasonography, Doppler, Transcranial
Vascular Stiffness
White Matter*

Figure

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  Fig. 1. Flow diagram for study subjects. MRA, magnetic resonance an-giography; TCD, transcranial Doppler; baPWV, brachial ankle pulse wave velocity; ABI, ankle-brachial index.

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  Fig. 2. In the receiver-operator characteristics, PI-MCA differentiated those with and without moderate-to-severe WMH with area under curve of 0.719 (95% CI, 0.65–0.832). However, the performance of baP-WV for predicting moderate-to-severe WMH was low, with area under curve of 0.625 (95% CI, 0.505–0.745). PI-MCA, pulsatility index of bilateral middle cerebral arteries; WMH, white matter hyperintensities; baPWV, brachial ankle pulse wave velocity; CI, confidence interval.

Reference

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