The relationship between aortic stiffness index and stroke severity in patients with acute ischemic stroke

Year 2021, , 1336 - 1343, 30.12.2021

Pınar Aydın Ozturk , Ünal Öztürk , Önder Öztürk

https://doi.org/10.17826/cumj.976695

Cited By: 1

Abstract

Purpose: Acute cerebrovascular diseases is an important reason of mortality and morbidity. Aortic stiffness is a important predictor of cerebrovascular, cardiovascular (CV) and all cause death, deadly and non-deadly coronary and neurologic situations, and severe strokes. In our study, we researched the association between aortic stiffness index (ASI) and stroke seriousness in acute ischemic stroke patients.
Materials and Methods: A total of 97 patients (females, 55; males, 42; 65 ± 16 years) with acute ischemic stroke were enrolled in this study. 17 patients were excluded. 80 patients were evaluated. Subjects were categorized into two groups according to the calculated NIHSS score (Group 1, NIHSS score < 16; Group 2, NIHSS score ≥ 16). Clinical characteristics, echocardiographic and laboratory parameters for all patients were evaluated. Cardiac parameters and aortic stiffness index were evaluated by two-dimensional echocardiography within 48 hours of hospitalization to the neurology clinic.
Results: There were no significant differences among the groups for age, gender, hypertension, diabetes mellitus, smoking, SBP, DBP, heart rate, dyslipidemia, infarct volume, troponin, HbA1c, glucose, creatinine, LDL cholesterol were significantly higher in Group 2 patients than in Group 1 patients. LV wall thickness, aortic stiffness index, E/e’ were significantly higher in Group 2 patients than in Group 1 patients. LVEF was significantly lower in Group 2 patients than in Group 1 patients.
Conclusion: ASI was significantly higher in patients with severe acute ischemic stroke. Higher ASI is associated with higher NIHSS score in patients with acute ischemic stroke

Keywords

Aortic stiffness index, echocardiography, stroke, cerebrovascular disease.

Akut iskemik inmeli hastalarda aortik stiffnes indeksi ile inme şiddeti arasındaki ilişki

Abstract

Amaç: Akut serebrovasküler hastalıklar önemli bir mortalite ve morbidite nedenidir. Aortik Stiffnes İndeksi, serebrovasküler, kardiyovasküler ve tüm nedenlere bağlı ölüm, ölümcül ve ölümcül olmayan koroner ve nörolojik durumlar ve ciddi inmelerin önemli bir belirleyicidir. Çalışmamızda akut iskemik inmeli hastalarda Aortik Stiffnes İndeksi (ASI) ile inme ciddiyeti arasındaki ilişkiyi araştırdık.
Gereç ve Yöntem: Bu çalışmaya akut iskemik inmeli toplam 97 hasta (kadın, 55; erkek, 42; 65 ± 16 yıl) alındı. 17 hasta çalışma dışı bırakıldı. 80 hasta değerlendirildi. Hastalar, hesaplanan NIHSS skoruna göre iki gruba ayrıldı (Grup 1, NIHSS skoru < 16; Grup 2, NIHSS skoru ≥ 16). Tüm hastaların klinik özellikleri, ekokardiyografik ve laboratuvar parametreleri değerlendirildi. Kardiyak parametreler ve ASI, nöroloji kliniğine yatıştan sonraki 48 saat içinde iki boyutlu ekokardiyografi ile değerlendirildi.
Bulgular: Gruplar arasında yaş, cinsiyet, hipertansiyon, diabetes mellitus, sigara kullanımı açısından anlamlı fark yoktu. SBP, DBP, kalp hızı, dislipidemi, enfarktüs hacmi, troponin, HbA1c, glukoz, kreatinin, LDL kolesterol, Grup 2 hastalarında Grup 1 hastalarına göre anlamlı derecede yüksekti. LV duvar kalınlığı, aortik stiffness indeksi, E/e', Grup 2 hastalarında Grup 1 hastalarına göre anlamlı olarak daha yüksekti. LVEF, Grup 2 hastalarında Grup 1 hastalarına göre anlamlı derecede daha düşüktü.
Sonuç: ASI, şiddetli akut iskemik inmeli hastalarda anlamlı olarak daha yüksekti. Bu çalışmanın sonucunda, akut iskemik inmeli hastalarda daha yüksek ASI'nin, daha yüksek NIHSS skoru ile ilişkili olabileceği öne sürülebilir.

Keywords

Aortik Stiffnes İndeksi, ekokardiyografi, inme, serebrovasküler hastalık

References

• 1. Byun DS, Han SW, Park JH, Kim JY, Baik JS, Park JH. Relationship between augmentation index and acute ischemic stroke subtype. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2014;21(7):1220-4.
• 2. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113(5):657-63.
• 3. Tuttolomondo A, Di Sciacca R, Di Raimondo D, Serio A, D'Aguanno G, Pinto A, et al. Arterial stiffness indexes in acute ischemic stroke: relationship with stroke subtype. Atherosclerosis. 2010;211(1):187-94.
• 4. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. European heart journal. 2006;27(21):2588-605.
• 5. Pannier BM, Avolio AP, Hoeks A, Mancia G, Takazawa K. Methods and devices for measuring arterial compliance in humans. American journal of hypertension. 2002;15(8):743-53.
• 6. Gosse P, Lasserre R, Minifie C, Lemetayer P, Clementy J. Arterial stiffness evaluated by measurement of the QKD interval is an independent predictor of cardiovascular events. American journal of hypertension. 2005;18(4 Pt 1):470-6.
• 7. Saji N, Kimura K, Kawarai T, Shimizu H, Kita Y. Arterial stiffness and progressive neurological deficit in patients with acute deep subcortical infarction. Stroke. 2012;43(11):3088-90.
• 8. Lyden P. Using the National Institutes of Health Stroke Scale: A Cautionary Tale. Stroke. 2017;48(2):513-9.
• 9. Zoppini G, Bergamini C, Trombetta M, Sabbagh L, Dauriz M, Mantovani A, et al. Increased aortic stiffness index in patients with type 1 diabetes without cardiovascular disease compared to controls. Journal of endocrinological investigation. 2019;42(9):1109-15.
• 10. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2015;28(1):1-39.e14.
• 11. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89.
• 12. Yoon HJ, Kim KH, Lee SH, Yim YR, Lee KJ, Park KH, et al. Differences of aortic stiffness and aortic intima-media thickness according to the type of initial presentation in patients with ischemic stroke. Journal of cardiovascular ultrasound. 2013;21(1):12-7.
• 13. Geroulakos G, O'Gorman D, Nicolaides A, Sheridan D, Elkeles R, Shaper AG. Carotid intima-media thickness: correlation with the British Regional Heart Study risk score. Journal of internal medicine. 1994;235(5):431-3.
• 14. Stefanadis C, Wooley CF, Bush CA, Kolibash AJ, Boudoulas H. Aortic distensibility abnormalities in coronary artery disease. The American journal of cardiology. 1987;59(15):1300-4.
• 15. Tuttolomondo A, Di Sciacca R, Di Raimondo D, Serio A, D'Aguanno G, Pinto A, et al. Corrigendum to "Arterial stiffness indexes in acute ischemic stroke: Relationship with stroke subtype" [Atherosclerosis 211 (2010) 187-194]. Atherosclerosis. 2016;255:228.
• 16. Manzano JJ, Omar E, Wong MC, De Silva DA. Arterial stiffness and ischemic stroke subtypes. Atherosclerosis. 2011;217(1):72-3.
• 17. Wu CY, Wu HM, Lee JD, Weng HH. Stroke risk factors and subtypes in different age groups: a hospital-based study. Neurology India. 2010;58(6):863-8.
• 18. Ikonomidis I, Makavos G, Lekakis J. Arterial stiffness and coronary artery disease. Current opinion in cardiology. 2015;30(4):422-31.
• 19. Fauchier L, Bodin A, Bisson A, Herbert J, Spiesser P, Clementy N, et al. Incident Comorbidities, Aging and the Risk of Stroke in 608,108 Patients with Atrial Fibrillation: A Nationwide Analysis. Journal of clinical medicine. 2020;9(4).
• 20. Lee GB, Shim JS, Kim HC. Dose-Response Association between Smoking Cessation and Arterial Stiffness: The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort. Korean circulation journal. 2020;50(4):361-9.
• 21. Park JS, Shin JH, Park JB, Choi DJ, Youn HJ, Park CG, et al. Relationship between arterial stiffness and circadian pattern of blood pressure. Medicine. 2019;98(12):e14953.
• 22. Li T, Zhu J, Fang Q, Duan X, Zhang M, Diao S, et al. Association of H-Type Hypertension with Stroke Severity and Prognosis. BioMed research international. 2018;2018:8725908.
• 23. Bonardo P, Pantiu F, Ferraro M, Chertcoff A, Bandeo L, Cejas LL, et al. Impact of Infarct Size on Blood Pressure in Young Patients with Acute Stroke. Journal of vascular and interventional neurology. 2018;10(1):14-6.
• 24. Mandraffino G, Scicali R, Rodriguez-Carrio J, Savarino F, Mamone F, Scuruchi M, et al. Arterial stiffness improvement after adding on PCSK9 inhibitors or ezetimibe to high-intensity statins in patients with familial hypercholesterolemia: A Two-Lipid Center Real-World Experience. Journal of clinical lipidology. 2020;14(2):231-40.
• 25. Ripoll JG, Blackshear JL, Diaz-Gomez JL. Acute Cardiac Complications in Critical Brain Disease. Neurosurgery clinics of North America. 2018;29(2):281-97.
• 26. Chang A, Ricci B, Grory BM, Cutting S, Burton T, Dakay K, et al. Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2019;28(6):1726-31.
• 27. Hendrix P, Sofoluke N, Adams MD, Kunaprayoon S, Zand R, Kolinovsky AN, et al. Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion. Stroke. 2019;50(5):1074-80.
• 28. Chirinos JA, Bhattacharya P, Kumar A, Proto E, Konda P, Segers P, et al. Impact of Diabetes Mellitus on Ventricular Structure, Arterial Stiffness, and Pulsatile Hemodynamics in Heart Failure With Preserved Ejection Fraction. Journal of the American Heart Association. 2019;8(4):e011457.
• 29. Lindsberg PJ, Roine RO. Hyperglycemia in acute stroke. Stroke. 2004;35(2):363-4.
• 30. Ryu WS, Bae EK, Park SH, Jeong SW, Schellingerhout D, Nahrendorf M, et al. Increased Left Ventricular Filling Pressure and Arterial Occlusion in Stroke Related to Atrial Fibrillation. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2018;27(5):1275-82.
• 31. Mostofsky E, Wellenius GA, Noheria A, Levitan EB, Burger MR, Schlaug G, et al. Renal function predicts survival in patients with acute ischemic stroke. Cerebrovascular diseases (Basel, Switzerland). 2009;28(1):88-94.