Change of the elasticity COEFFICIENT of the walls of the common carotid artery as a predictor of adverse cardiovascular events in hypertensive patients after ischemic hemispheric stroke. Results of one year observation.

Authors

  • O. A. Lisovaya

DOI:

https://doi.org/10.14739/2310-1237.2013.2.17790

Keywords:

arterial hypertension grade III, common carotid artery, distensibility coefficient, vascular remodeling, ischemic stroke, clinical outcomes, prognosis

Abstract

Objective. To evaluate the relationship between carotid artery elastic properties and risk of recurrent coronary and cerebral ischemic events in III grade arterial hypertension patients after ischemic stroke.

Methods. 102 mild-to-moderate arterial hypertension patients were enrolled to the scrutiny in 3 weeks after ischemic stroke and then they had been being studied prospectively for 12 months period regarding survival rate and unfavorable clinical outcomes. Clinical interviews were performed every 3 months during 1 year after blood sampling. Clinical events included the following: certainly diagnosed ischemic stroke or TIA; coronary ischemic events, sudden death, diabetes mellitus, and all cardiovascular events including chronic heart failure and hospitalization. Elastic properties of carotid artery were determined by high resolution B-modal echography.

Results. Univariate analysis has found that age-, gender-, index NIHSS-, Barthel index- and Rankin score index-adjusted variable of total cardiovascular events positively correlated with the presence of type 2 diabetes (R=0.62; P =0.001), systolic BP (R=0.50; P=0.022), the total cholesterol levels (R=0.56; P =0.004), and LDL cholesterol in plasma (R=0,64; P =0,012), fasting blood glucose (R=0,56; P =0,014), and negatively correlated with distensibility coefficient (R=-0.80; P=0.009), cross-section compliance of the common carotid artery (R=-0.70; P=0.004), of pressure-straine elastic modulus (R=-0.64; P =0.041), and the Young's modulus (R=-0.52; P=0.011). Multivariate analysis showed that after exclusion of all indicators with a high level of mutual associations among the variables that have demonstrated the existence of an independent significant association in linear regression with a total value of cardiovascular events elasticity (R = -0,76; P = 0,006), the level of total MS (R = 0,55; P = 0,009), and LDL cholesterol in plasma (R = 0,62; P = 0,014), diabetes mellitus type 2 (R = 0,62; P = 0,004) remained. The most optimal predictive value is the cutoff point of distensibility coefficient is equal to 27.05 kPa (AUC=0.847±0.038; 95% CI =0,774-0,921; sensitivity =90.6%, specificity=70.6%).

In conclusion, we suggested that decreased distensibility coefficient less than 27.05 kPa strongly predicts the risk for cumulative clinical cardiovascular events in arterial hypertensive patients after ischemic stroke.

References

Adams H.P. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial: TOAST: Trial of Org 10172 in Acute Stroke Treatment / Adams H.P., Bendixen B.H., Kappelle L.J. et al. // Stroke. – 1993. – Vol. 24. –Р. 35–41.

ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary // J. Neurointerv. Surg. – 2011. – Vol. 3(2). –Р. 100–130.

Chrysohoou C. Aortic elastic properties and cognitive function in elderly individuals: The Ikaria Study / Chrysohoou C., Psaltopoulou T., Panagiotakos D. et al. // Maturitas. – 2012. – Vol. 12. – Р. S0378–5122 (12)00379-9.

Collin C. The Barthel ADL Index: a reliability study/Collin C., Wade D.T., Davies S., Horne V. //IntDisabil Stud. – 1988. –Vol.10. – Р. 61–63.

Dolan E. Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in the Dublin Outcome Study/ Dolan E., Thijs L., Li Y. et al. //Hypertension. – 2006. – Vol.47. – Р. 365–370.

Elbasan Z. Aortic distensibility and extent and complexity of coronary artery disease in patients with stable hypertensive and nonhypertensive coronary artery disease/ Elbasan Z., Sahin D., Gür M. et al. // Med. Princ. Pract. – 2013. –Vol.22(3). – Р. 260–264.

Hacke W. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II)/ Hacke W., Kaste M., Fieschi C. et al. // Lancet. – 1998. – Vol.352. – Р. 1245–1251.

Kuzeytemiz M. The Effect of Non-dipper and Dipper Blood Pressure Patterns on Aortic Elasticity in Patients with Metabolic Syndrome / Kuzeytemiz M., Karaagac K., Vatansever F. et al.// ClinExpHypertens. – 2013. – Apr 3. [Epub ahead of print] [http://www.ncbi.nlm.nih.gov/pubmed? term=loftextAshley[filter]+AND+1064-1963].

Lacy P.S. Increased pulse wave velocity is not associated with elevated augmentation index in patients with diabetes / Lacy P.S., O’Brien D.G., Stanley A.G. et al. // J Hypertens. – 2004. –Vol.22. – Р. 1937–1944.

Laurent S. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients / Laurent S., Boutouyrie P., Asmar R. et al. //Hypertension. – 2001. –Vol.37. – Р. 1236–1241.

Li R. B-mode-detected carotid artery plaque in a general population / Li R., Duncan B.B., Metcalf P.A. et al. // Stroke. – 1994. – Vol. 25. – Р. 2377–2383.

Lyden P.D. A modified National Institutes of Health stroke scale for use in stroke clinical trials. Preliminary reliability and validity / Lyden P.D., Lu M., Levine S. et al. //Stroke. – 2001. –Vol.32. – Р. 1310–1317.

Manning T.S. Validity and reliability of diastolic pulse contour analysis (windkessel model) in humans / Manning T.S., Shykoff B.E., Izzo J.L. Jr. //Hypertension. – 2002. – Vol. 39. – Р. 963–896.

Matsuoka O. Arterial stiffness independently predicts cardiovascular events in an elderly community / Matsuoka O., Otsuka K., Murakami S. et al. //Biomed Pharmacother. – 2005. –Vol.59(Suppl 1). – Р. S40–44.

Nagai Y. Carotid arterial stiffness as a surrogate for aortic stiffness: relationship between carotid artery pressure-strain elastic modulus and aortic pulse wave velocity / Nagai Y., Fleg J.L., Kemper M.K. et al. // Ultrasound Med Biol. – 1999. – Vol. 25. – Р. 181–188.

Paini A. Carotid and aortic stiffness: determinants of discrepancies / Paini A., Boutouyrie P., Calvet D. et al. //Hypertension. – 2006. –Vol.47. – Р. 371–376.

Park S.M. Assessment of the arterial stiffness index as a clinical parameter for atherosclerotic coronary artery disease / Park S.M., Seo H.S., Lim H.E. et al. // Korean Circ J. – 2004. – Vol. 34. – Р. 677–683.

Sacks D.B. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus / Sacks D.B., Arnold M., Bakris G.L. et al. // Clin. Chem. – 2011. – Vol. 57(6). – Р.e1–e47.

Safar M.E. Arterial Stiffness in Hypertension / Safar M.E., O’Rourke M.F. –Amsterdam: Elsevier, 2006. –Р. 53–62.

Sahіn D.Y. Myocardial performance index and aortic distensibility in patients with different left ventricle geometry in newly diagnosed essential hypertension / Sahіn D.Y., Gür M., Elbasan Z. et al. // Blood Press. – 2013. – Apr 3. [Epub ahead of print] [https://www.ncbi.nlm.nih.gov/m/pubmed/23550550/?i=4]

Schillaci G. Ambulatory arterial stiffness index is not a specific marker of reduced arterial compliance / Schillaci G., Parati G., Pirro M. et al. //Hypertension. – 2007. – Vol. 49. – Р. 986–991.

Tok D. Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study/ Tok D., Ozcan F., Kadife I. et al. //AnadoluKardiyolDerg. – 2013. [Epub ahead of print] [http://www.anakarder.com/eng/yazilar.asp?yaziid=2855&sayiid=32].

Voges I. Implications of early aortic stiffening in patients with transposition of the great arteries after arterial switch operation/Voges I., Jerosch-Herold M., Hedderich J. et al. //Circ. Cardiovasc. Imaging. – 2013. – Vol. 6(2). – Р. 245–253.

Williams S.V. Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification / Williams S.V., Fihn S.D., Gibbons R.J. //Ann Intern Med. – 2001. –Vol.135(7). – Р. 530–547.

Willum-Hansen T. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population / Willum-Hansen T., Staessen J.A., Torp-Pedersen C. et al. // Circulation. – 2006. – Vol. 113. – Р. 664–670.

Published

2013-10-14

How to Cite

1.
Lisovaya OA. Change of the elasticity COEFFICIENT of the walls of the common carotid artery as a predictor of adverse cardiovascular events in hypertensive patients after ischemic hemispheric stroke. Results of one year observation. Pathologia [Internet]. 2013Oct.14 [cited 2024Mar.29];(2). Available from: http://pat.zsmu.edu.ua/article/view/17790

Issue

Section

Original research