scholarly journals Aortic Stiffness, Pulse Pressure, and Cerebral Pulsatility Progress Despite Best Medical Management: The OXVASC Cohort

Stroke ◽  
2021 ◽  
Author(s):  
Alastair J.S. Webb ◽  
Amy Lawson ◽  
Karolina Wartolowska ◽  
Sara Mazzucco ◽  
Peter M. Rothwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medical Treatment ◽  
Aortic Stiffness ◽  
Small Vessel Disease ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Cerebral Small Vessel Disease ◽  
Intraclass Correlation Coefficients ◽  
Vessel Disease ◽  
Best Medical Treatment

Background and Purpose: Increased cerebral arterial pulsatility is associated with cerebral small vessel disease, recurrent stroke, and dementia despite the best medical treatment. However, no study has identified the rates and determinants of progression of arterial stiffness and pulsatility. Methods: In consecutive patients within 6 weeks of transient ischemic attack or nondisabling stroke (OXVASC [Oxford Vascular Study]), arterial stiffness (pulse wave velocity [PWV]) and aortic systolic, aortic diastolic, and aortic pulse pressures (aoPP) were measured by applanation tonometry (Sphygmocor), while middle cerebral artery (MCA) peak (MCA-PSV) and trough (MCA-EDV) flow velocity and Gosling pulsatility index (PI; MCA-PI) were measured by transcranial ultrasound (transcranial Doppler, DWL Doppler Box). Repeat assessments were performed at the 5-year follow-up visit after intensive medical treatment and agreement determined by intraclass correlation coefficients. Rates of progression and their determinants, stratified by age and sex, were determined by mixed-effects linear models, adjusted for age, sex, and cardiovascular risk factors. Results: In 188 surviving, eligible patients with repeat assessments after a median of 5.8 years. PWV, aoPP, and MCA-PI were highly reproducible (intraclass correlation coefficients, 0.71, 0.59, and 0.65, respectively), with progression of PWV (2.4%; P <0.0001) and aoPP (3.5%; P <0.0001) but not significantly for MCA-PI overall (0.93; P =0.22). However, PWV increased at a faster rate with increasing age (0.009 m/s per y/y; P <0.0001), while aoPP and MCA-PI increased significantly above the age of 55 years (aoPP, P <0.0001; MCA-PI, P =0.009). Higher aortic systolic blood pressure and diastolic blood pressure predicted a greater rate of progression of PWV and aoPP, but not MCA-PI, although current MCA-PI was particularly strongly associated with concurrent aoPP ( P <0.001). Conclusions: Arterial pulsatility and aortic stiffness progressed significantly after 55 years of age despite the best medical treatment. Progression of stiffness and aoPP was determined by high blood pressure, but MCA-PI predominantly reflected current aoPP. Treatments targetting cerebral pulsatility may need to principally target aortic stiffness and pulse pressure to have the potential to prevent cerebral small vessel disease.

Ambulatory Blood Pressure Levels in the Prediction of Progression of Cerebral Small Vessel Disease

2020 ◽  
Vol 68 (10) ◽  
pp. 2232-2239
Author(s):  
Joan Jiménez‐Balado ◽  
Iolanda Riba‐Llena ◽  
Olga Maisterra ◽  
Jesús Pizarro ◽  
Antoni Palasí ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease

scholarly journals Blood pressure and sodium: Association with MRI markers in cerebral small vessel disease

2015 ◽  
Vol 36 (1) ◽  
pp. 264-274 ◽  
Author(s):  
Anna K Heye ◽  
Michael J Thrippleton ◽  
Francesca M Chappell ◽  
Maria del C Valdés Hernández ◽  
Paul A Armitage ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Small Vessel Disease ◽  
Sodium Concentration ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Plasma Sodium ◽  
Dietary Salt ◽  
Vessel Disease ◽  
Plasma Sodium Concentration

Dietary salt intake and hypertension are associated with increased risk of cardiovascular disease including stroke. We aimed to explore the influence of these factors, together with plasma sodium concentration, in cerebral small vessel disease (SVD). In all, 264 patients with nondisabling cortical or lacunar stroke were recruited. Patients were questioned about their salt intake and plasma sodium concentration was measured; brain tissue volume and white-matter hyperintensity (WMH) load were measured using structural magnetic resonance imaging (MRI) while diffusion tensor MRI and dynamic contrast-enhanced MRI were acquired to assess underlying tissue integrity. An index of added salt intake ( P = 0.021), pulse pressure ( P = 0.036), and diagnosis of hypertension ( P = 0.0093) were positively associated with increased WMH, while plasma sodium concentration was associated with brain volume ( P = 0.019) but not with WMH volume. These results are consistent with previous findings that raised blood pressure is associated with WMH burden and raise the possibility of an independent role for dietary salt in the development of cerebral SVD.

scholarly journals Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population

2020 ◽  
Vol 74 (2) ◽  
pp. 463-472 ◽  
Author(s):  
Rianne A.A. de Heus ◽  
Stacha F.I. Reumers ◽  
Alba van der Have ◽  
Maxime Tumelaire ◽  
Phillip J. Tully ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Disease Burden ◽  
Small Vessel Disease ◽  
Home Blood Pressure ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Memory Clinic ◽  
Vessel Disease ◽  
Clinic Population

Abstract 3208: Sensitivity and Reliability of SWI Compared to T2* GRE MRI for Detection of Microbleeds in Cerebral Amyloid Angiopathy

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ah-Ling Cheng ◽  
Cheryl R McCreary ◽  
M. L Lauzon ◽  
Richard Frayne ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Cerebral Amyloid Angiopathy ◽  
Small Vessel Disease ◽  
Intraclass Correlation ◽  
Case Series ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Amyloid Angiopathy ◽  
Healthy Controls ◽  
Vessel Disease ◽  
Cerebral Amyloid

Introduction: Case examples and small case series suggest that MRI susceptibility weighted imaging (SWI) may be more sensitive for cerebral microbleed (CMB) detection compared to MRI T2* gradient-recalled echo (GRE). However, there are few data on CMB counts measured by SWI vs. GRE, or inter-rater reliability, in groups of patients with cerebral small vessel disease. We used data from a prospective cohort study of cerebral amyloid angiopathy (CAA), a cerebral small-vessel disease marked by high numbers of CMBs, to quantify the sensitivity and reliability of SWI vs. GRE for CMB detection. Methods: Nine patients with symptomatic CAA (mean age 71±8.3; 7 males and 2 females) and 21 healthy non-CAA controls (mean age 68±6.3; 10 M/11 F) underwent T2* GRE and SWI on a 3.0T MR scanner. Probable CAA was diagnosed according to the Boston criteria prior to study entry using information from clinical MRI with GRE sequences. Two raters (labeled 1 and 2) independently interpreted the GRE and SWI scans blinded to clinical information. The phase-filtered magnitude image was used for SWI interpretation. Agreement reliability was assessed using the kappa coefficient (where a kappa of ≥0.60 indicates good agreement) or the intraclass correlation coefficient (ICC). Results: Overall, the raters identified 1,432 CMBs in the 9 CAA cases (range 1-434 per patient) and 8 CMBs in the healthy controls (range 0-3). Rater 1 identified CMBs in 5/21 healthy controls on SWI and 5/21 on GRE, while rater 2 identified CMBs in 4/21 on SWI and 3/21 on GRE (kappa 0.70 for GRE and 0.57 for SWI). In CAA cases more CMBs were seen on SWI compared to the GRE sequence but the difference was significant only for rater 1 (rater 1: on average 85% more per patient on SWI than on GRE, p=0.008; rater 2: 19% more, p=0.25). Among CAA cases the reliability between raters was poor for GRE (ICC 0.36) but excellent for SWI (0.94, p<0.05 for comparison with GRE). Review suggested that the differing reliability was because rater 1 was less likely than rater 2 to identify faint lesions on GRE as CMB, whereas these lesions were more conspicuous on SWI. If SWI rather than GRE were used to determine CAA status according to the Boston criteria, all 9 CAA cases would remain classified as probable CAA but 2/21 controls would be reclassified as either possible (n=1) or probable (n=1) asymptomatic CAA based on the detection of one or more lobar microbleeds on SWI. Conclusions: SWI confers greater reliability as well as greater sensitivity for CMB detection compared to GRE, and should be the preferred sequence for quantifying CMBs. SWI may more frequently identify lobar microbleeds that could represent asymptomatic CAA. Further research is needed to determine whether the Boston criteria require revision to take into account the greater sensitivity of SWI for CMB detection.

Blood pressure variability and leukoaraiosis amount in cerebral small-vessel disease

2001 ◽  
Vol 104 (6) ◽  
pp. 358-363 ◽  
Author(s):  
J. Martí-Fàbregas ◽  
C. Valencia ◽  
J. Pujol ◽  
C. García-Sánchez ◽  
A. Roca-Cusachs ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease
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