Soulat Gilles, Jarvis Kelly, Pathrose Ashitha, Vali Alireza, Scott Michael, Syed Amer A, Kinno Menhel, Prabhakaran Shyam, Collins Jeremy D, Markl Michael
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA.
J Magn Reson Imaging. 2021 Jan;53(1):213-221. doi: 10.1002/jmri.27279. Epub 2020 Aug 7.
Blood flow reversal is a possible mechanism for retrograde embolism in the setting of high-risk atherosclerotic plaques in the descending aorta (DAo). Evidence suggests that pulse wave velocity (PWV) is a determinant of blood flow reversal and can be reduced by the destiffening effect of renin-angiotensin system inhibitors (RASI).
To evaluate the impact of antihypertensive therapy on in vivo changes in PWV and flow reversal in patients with cryptogenic stroke.
Prospective.
Sixteen patients (69 ± 9 years; 10 males) included after cryptogenic stroke.
FIELD STRENGTH/SEQUENCE: 3T. 4D flow sequence (temporal resolution = 19.6 msec) ASSESSMENT: Patients underwent aortic MRI at baseline and at 6-month follow-up. Patients received standard-of-care antihypertensive therapy that were classified as RASI vs. non-RASI medications (ie, destiffening vs. nondestiffening).We compared aortic PWV, flow reversal fraction (FRF), aortic measurements, cardiac function, and other aortic and cardiac measurements in the antihypertensive therapy groups.
Two-tailed paired or unpaired Student's t-tests (normal distributions) or Wilcoxon tests (nonnormal distribution). Univariate correlations using Pearson correlation coefficients.
There was a significant decrease in PWV in the RASI (n = 10) group (9.4 ± 1.6 m/s vs. 8.3 ± 1.9 m/s; P < 0.05), as well as FRF (18.6% ± 4.1% vs. 16.3% ± 4.0%; P < 0.05) between baseline and the 6-month MRI studies. There were no changes in PWV or FRF in the non-RASI (n = 6) group (P = 0.146 and P = 0.32). A decrease in FRF was significantly correlated with a decrease in PWV (r = 0.53; P < 0.05).
The findings of our study suggest that RASI therapy after cryptogenic stroke resulted in a decrease of blood flow reversal and aortic stiffness.
1 TECHNICAL EFFICACY STAGE: 4.
在降主动脉（DAo）高危动脉粥样硬化斑块的情况下，血流逆转是逆行栓塞的一种可能机制。有证据表明，脉搏波速度（PWV）是血流逆转的一个决定因素，并且可以通过肾素 - 血管紧张素系统抑制剂（RASI）的去硬化作用而降低。
评估抗高血压治疗对不明原因卒中患者体内PWV变化和血流逆转的影响。
前瞻性研究。
16例不明原因卒中后患者（69±9岁；10例男性）。
场强/序列：3T。4D血流序列（时间分辨率 = 19.6毫秒）
患者在基线和6个月随访时接受主动脉MRI检查。患者接受标准护理抗高血压治疗，分为RASI药物组和非RASI药物组（即去硬化药物组和非去硬化药物组）。我们比较了抗高血压治疗组之间的主动脉PWV、血流逆转分数（FRF）、主动脉测量值、心功能以及其他主动脉和心脏测量值。
双尾配对或非配对学生t检验（正态分布）或威尔科克森检验（非正态分布）。使用皮尔逊相关系数进行单变量相关性分析。
RASI组（n = 10）在基线和6个月MRI研究之间，PWV显著降低（9.4±1.6米/秒对8.3±1.9米/秒；P < 0.05），FRF也显著降低（18.6%±4.1%对16.3%±4.0%；P < 0.05）。非RASI组（n = 6）的PWV或FRF没有变化（P = 0.146和P = 0.32）。FRF的降低与PWV的降低显著相关（r = 0.53；P < 0.05）。
我们的研究结果表明，不明原因卒中后接受RASI治疗可导致血流逆转和主动脉僵硬度降低。
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