Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, UK.
Cerebrovasc Dis. 2023;52(2):194-201. doi: 10.1159/000525764. Epub 2022 Aug 23.
Arterial stiffness, cerebral pulsatility, and beat-to-beat blood pressure variability partly mediate the relationship between hypertension and stroke, but it is unknown if these intermediate phenotypes of vascular ageing differ between stroke aetiologies. We therefore aimed to characterize differences in these intermediate cardiovascular phenotypes between patients presenting with strokes of different aetiologies.
In consecutive patients on best medical management 1 month after TIA or nondisabling stroke (Oxford Vascular Study), arterial stiffness (PWV) was measured by applanation tonometry (Sphygmocor), middle cerebral blood flow velocity, and pulsatility index (MCA-PI) were measured by transcranial ultrasound (TCD, DWL Doppler Box), and beat-to-beat BP variability was measured with a Finometer. Differences between patients with large artery (LAS), small vessel (SVD), cardioembolic (CE), or undetermined events were derived, including adjustment for cardiovascular risk factors. Relationships were characterized by mixed linear models.
In 909 eligible patients, MCA-PI, PWV, and SBPV were all positively skewed. Mean values were greatest in LAS than CE and lowest in SVD (p < 0.001). However, after adjustment for age, sex, and risk factors, PI was greatest in LAS and lowest in CE stroke, whilst PWV was greatest in SVD and undetermined stroke (p < 0.001). In multivariate linear models, age was more strongly associated with PWV and PI in patients with small vessel stroke than other aetiologies, particularly under the age of 65, but SBPV was only weakly associated with demographic indices in all stroke subtypes.
Intermediate cardiovascular phenotypes of vascular ageing had similar demographic associations between stroke aetiologies, but these were particularly strong in patients with small vessel stroke under the age of 65, implying a potential role of these phenotypes in increasing stroke risk in this patient group.
动脉僵硬度、脑搏动性和血压变异性的逐拍变化部分介导了高血压与中风之间的关系，但尚不清楚血管老化的这些中间表型在不同中风病因之间是否存在差异。因此，我们旨在描述不同病因引起的中风患者这些中间心血管表型的差异。
在 TIA 或非致残性中风后 1 个月接受最佳药物治疗的连续患者中，通过平板张力测量法（Sphygmocor）测量动脉僵硬度（PWV），通过经颅超声（TCD、DWL 多普勒盒）测量大脑中动脉血流速度和搏动指数（MCA-PI），通过 Finometer 测量逐拍血压变异性。得出大动脉（LAS）、小血管（SVD）、心源性栓塞（CE）或未确定事件患者之间的差异，包括对心血管危险因素进行调整。通过混合线性模型描述关系。
在 909 名符合条件的患者中，MCA-PI、PWV 和 SBPV 均呈正偏态分布。平均值在 LAS 中最大，在 CE 中最小，在 SVD 中最小（p<0.001）。然而，在调整年龄、性别和危险因素后，PI 在 LAS 中最大，在 CE 中风中最小，而 PWV 在 SVD 和未确定中风中最大（p<0.001）。在多元线性模型中，年龄与小血管中风患者的 PWV 和 PI 相关性更强，而与其他病因的相关性较弱，特别是在 65 岁以下的患者中，但 SBPV 仅与所有中风亚型的人口统计学指数有弱相关性。
血管老化的中间心血管表型在中风病因之间具有相似的人口统计学关联，但在 65 岁以下的小血管中风患者中尤其强烈，这表明这些表型在增加该患者群体的中风风险方面可能具有潜在作用。
