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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 inson-ation 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 moder-ate-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. Uni-variate analysis showed old age and high PI-MCA were significantly correlated with moder-ate-to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivar-iate 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-se-vere 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.
References
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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.
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.
Table 1.
Baseline characteristics
Table 2.
Factors associated with white matter hyperintensities in univariate analysis
| White matter hyperintensity | p-valuea | ||
|---|---|---|---|
| Absent or mild (N = 39) | Moderate or severe (N = 44) | ||
| Age, years, mean (SD) | 56.5 (11.4) | 65.9 (9.5) | < 0.001 |
| Sex, women, n (%) | 10 (37.0) | 17 (63.0) | 0.207 |
| Previous stroke, n (%) | 34 (50.7) | 33 (49.3) | 0.16 |
| Hypertension, n (%) | 18 (54.5) | 15 (45.5) | 0.262 |
| Diabetes, n (%) | 28 (46.7) | 32 (53.3) | 0.925 |
| Hyperlipidemia, n (%) | 29 (44.6) | 36 (55.4) | 0.411 |
| Current smoker, n (%) | 20 (44.4) | 25 (55.6) | 0.613 |
| Baseline mean NIHSS (SD) | 2.1 (1.5) | 2.7 (2.1) | 0.175 |
| baPWV | 0.082 | ||
| Low, n (%) | 16 (59.3) | 11 (40.7) | |
| Intermediate, n (%) | 13 (46.4) | 15 (53.6) | |
| High, n (%) | 10 (35.7) | 18 (64.3) | |
| PI-MCA | < 0.001 | ||
| Low, n (%) | 20 (74.1) | 7 (25.9) | |
| Intermediate, n (%) | 12 (42.9) | 16 (57.1) | |
| High, n (%) | 7 (25.0) | 21 (75.0) | |
Table 3.
Predicting facotrs for moderate-to-severe white matter hyperintensities in multivariate analysis
| Model 1 | Model 2 | |||||||
|---|---|---|---|---|---|---|---|---|
| p-valuea | HR | 95% CI | p-valuea | HR | 95% CI | |||
| Age | 0.001 | 1.108 | 1.044 | 1.175 | 0.044 | 1.068 | 1.002 | 1.138 |
| Sex (women) | 0.994 | 0.995 | 0.275 | 3.599 | 0.894 | 0.916 | 0.252 | 3.325 |
| Previous stroke | 0.858 | 1.129 | 0.298 | 4.275 | 0.497 | 1.637 | 0.395 | 6.791 |
| Hypertension | 0.115 | 2.44 | 0.805 | 7.4 | 0.119 | 2.473 | 0.793 | 7.709 |
| Diabetes | 0.463 | 0.64 | 0.195 | 2.106 | 0.779 | 0.848 | 0.268 | 2.684 |
| Hyperlipidemia | 0.292 | 0.517 | 0.152 | 1.765 | 0.326 | 0.523 | 0.144 | 1.905 |
| Current smoker | 0.237 | 2.17 | 0.601 | 7.835 | 0.116 | 2.827 | 0.774 | 10.324 |
| baPWV | ||||||||
| Low | Ref. | |||||||
| Intermediate | 0.222 | 2.215 | 0.619 | 7.934 | ||||
| High | 0.385 | 1.805 | 0.476 | 6.842 | ||||
| PI-MCA | ||||||||
| Low | Ref. | |||||||
| Intermediate | 0.136 | 2.677 | 0.733 | 9.775 | ||||
| High | 0.049 | 5.138 | 1.01 | 26.15 | ||||
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