Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom.
Stroke. 2022 Apr;53(4):1310-1317. doi: 10.1161/STROKEAHA.121.035560. Epub 2021 Dec 2.
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.
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.
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%; <0.0001) and aoPP (3.5%; <0.0001) but not significantly for MCA-PI overall (0.93; =0.22). However, PWV increased at a faster rate with increasing age (0.009 m/s per y/y; <0.0001), while aoPP and MCA-PI increased significantly above the age of 55 years (aoPP, <0.0001; MCA-PI, =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 (<0.001).
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.
尽管进行了最佳的医学治疗，大脑动脉搏动性增加与脑小血管疾病、复发性中风和痴呆有关。然而，尚无研究确定动脉僵硬和搏动性进展的速度和决定因素。
在短暂性脑缺血发作或非致残性中风后 6 周内连续入组的患者（OXVASC [牛津血管研究]），通过平板测压法（Sphygmocor）测量动脉僵硬（脉搏波速度 [PWV]）和主动脉收缩压、主动脉舒张压和主动脉搏动压（aoPP），通过经颅超声（经颅多普勒，DWL 多普勒盒）测量大脑中动脉（MCA）峰值（MCA-PSV）和低谷（MCA-EDV）流速和 Gosling 搏动指数（MCA-PI）。在强化药物治疗后 5 年的随访时进行重复评估，并通过组内相关系数确定一致性。通过混合效应线性模型确定按年龄和性别分层的进展速度及其决定因素，并针对年龄、性别和心血管危险因素进行调整。
在 188 名有重复评估且中位随访时间为 5.8 年的存活合格患者中，PWV、aoPP 和 MCA-PI 具有高度可重复性（组内相关系数分别为 0.71、0.59 和 0.65），PWV（2.4%；<0.0001）和 aoPP（3.5%；<0.0001）均有进展，但总体 MCA-PI 无显著变化（0.93；=0.22）。然而，PWV 的增加速度随年龄的增加而加快（每增加 1 岁增加 0.009m/s；<0.0001），而 aoPP 和 MCA-PI 在 55 岁以上时显著增加（aoPP，<0.0001；MCA-PI，=0.009）。较高的主动脉收缩压和舒张压预测 PWV 和 aoPP 的进展速度更快，但 MCA-PI 则与同期 aoPP 关系更为密切（<0.001）。
尽管进行了最佳的医学治疗，动脉搏动性和主动脉僵硬在 55 岁以后仍显著进展。僵硬和 aoPP 的进展取决于高血压，但 MCA-PI 主要反映当前的 aoPP。针对大脑搏动性的治疗可能需要主要针对主动脉僵硬和脉搏压，以有潜力预防脑小血管疾病。
