Assesment Of Cerebral Blood Flow Velocity By Transcranial Doppler Ultrasonography In Patients With Polycystic Ovary Syndrome

Öz

Aim: In this study, we aimed to evaluate the blood flow velocities of middle cerebral artery via transcranial doppler ultrasonography TCD and to assess subclinical vasculer involvement in premenopausal young women diagnosed with PCOS.Material and Methods: This prospective and observational study included 28 female patients with polcystic over syndrome and 23 healthy female hospital staff as controls. Demographic characteristics of the participants were recorded and TCD examination was performed on the middle cerebral arteries. TCD parameters; mean cerebral blood flow velocity MCBFV , peak systolic velocity PSV , pulsatility index PI , resistance index RI and systolic /diastolic ratio S / D were assessed.Results: PCOS and control groups were similar in terms of age. Body mass index BMI , diastolic and mean blood pressures were higher in the PCOS group than those in the control group. There were no significant differences between TCD parameters; MCBFV, PSV, PI, RI, S/D of PCOS and control group on the middle cerebral arteries. In the PCOS group, no correlation was found in between TCD parameters and age, BMI.Conclusion: In our study, cerebral blood flow velocities evaluated with TCD in early premenopausal PCOS patients were not different from healthy controls. However, the increased risk of cardiovascular and cerebrovascular diseases in postmenopausal PCOS patients suggests that the metabolic processes and microvascular effects initiated by PCOS are time-dependent and increase with age.

Anahtar Kelimeler

• Polycystic ovary syndrome,hyperandrogenism,transcranial doppler ultrasonography,middle cerebral artery,blood flow velocity

Polikistik Over Sendromlu Hastalarda Transkraniyal Doppler Ultrasonografi İle Serebral Kan Akım Hızının Değerlendirilmesi

Öz

Amaç: Bu çalışmada amacımız, PKOS tanısıyla izlenen premenapozal genç kadınlarda transkraniyal doppler ultrasonografi TCD ile orta serebral arter kan akım hızlarını incelemek ve subklinik vaskuler tutulumu araştırmaktır.Gereç ve Yöntemler: Prospektif ve gözlemsel olarak planlanan bu çalışmaya polikistik over sendromu tanısı almış 28 kadın hasta ve 23 sağlıklı kadın hastane personeli kontrol olarak dahil edildi. Katılımcıların demografik özellikleri kaydedilerek, orta serebral arterlere TCD incelemesi yapıldı. TCD parametreleri; ortalama serebral kan akım hızı OSKAH , pik sistolik hız PSH , pulsatilite indeksi PI , rezistans indeksi RI , sistolik/ diastolik oranı S/D değerlendirildi.Bulgular: PKOS ve kontrol grubu, yaş bakımından benzerdi. Vücut kitle indeksi, diastolik ve ortalama kan basıncı değerleri PKOS grubunda kontrol grubuna göre yüksek bulundu. PKOS ve kontrol grubunun orta serebral arterden yapılan TCD parametreleri; OSKAH, PSH, PI, RI, S/D arasında anlamlı farklılık yoktu. PKOS grubunda, TCD parametreleri ile yaş, VKİ arasında herhangi korelasyon saptanmadı.Sonuç: Bu çalışmada, erken premenapozal PKOS hastalarında TCD ile serebral kan akım hızları normal kontrollerden farklı bulunmamıştır. Ancak postmenapozal PKOS hastalarında ortaya konmuş olan artmış kardiyovaskuler ve serebrovaskuler risk, PKOS’un başlattığı metabolik süreçler ve mikrovaskuler etkilenmelerin zaman bağımlı olup yaşlanmayla arttığını düşündürmektedir.

Anahtar Kelimeler

• Polikistik over sendromu,hyperandrogenism,transkraniyal doppler ultrasonografi,orta serebral arter,kan akım hızı.

Kaynakça

1. Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metab. 1999;84(6):1897-9.
2. Bajuk Studen K, Pfeifer M. Cardiometabolic risk in polycystic ovary synd- rome. Endocr Connect. 2018.
3. Rotterdam EA-SPCWG. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.
4. McCartney CR, Marshall JC. CLINICAL PRACTICE. Polycystic Ovary Sy- ndrome. N Engl J Med. 2016;375(1):54-64.
5. Zhou Y, Wang X, Jiang Y, Ma H, Chen L, Lai C, et al. Association between polycystic ovary syndrome and the risk of stroke and all-cause mortality: insights from a meta-analysis. Gynecol Endocrinol. 2017;33(12):904-10.
6. Meyer ML, Malek AM, Wild RA, Korytkowski MT, Talbott EO. Carotid ar- tery intima-media thickness in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(2):112-26.
7. Guzick DS, Talbott EO, Sutton-Tyrrell K, Herzog HC, Kuller LH, Wolfson SK, Jr. Carotid atherosclerosis in women with polycystic ovary synd- rome: initial results from a case-control study. Am J Obstet Gynecol. 1996;174(4):1224-9; discussion 9-32.
8. Senturk LM, Imamoglu M. Polikistik Over Sendromunda Klinik ve Tani Kri- terleri. Turkiye Klinikleri 2013;6(4):10-6.

9. D’Andrea A, Conte M, Cavallaro M, Scarafile R, Riegler L, Cocchia R, et al. Transcranial Doppler ultrasonography: From methodology to major clinical applications. World J Cardiol. 2016;8(7):383-400.
10. Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neuro- surg. 1982;57(6):769-74.
11. Batur Caglayan HZ, Nazliel B, Cinar M, Ataoglu E, Moraloglu O, Irkec C. Assessment of maternal cerebral blood flow velocity by transcranial Doppler ultrasound before delivery and in the early postpartum period. J Matern Fetal Neonatal Med. 2017:1-6.
12. Nandi A, Chen Z, Patel R, Poretsky L. Polycystic ovary syndrome. Endoc- rinol Metab Clin North Am. 2014;43(1):123-47.
13. Vural B, Caliskan E, Turkoz E, Kilic T, Demirci A. Evaluation of metabolic syndrome frequency and premature carotid atherosclerosis in young wo- men with polycystic ovary syndrome. Hum Reprod. 2005;20(9):2409-13.
14. Kizkin S, Engin-Ustun Y, Ustun Y, Ozcan C, Serbest S, Ozisik HI. Cerebral artery hemodynamics in polycystic ovary syndrome. Gynecol Endocri- nol. 2005;21(5):287-91.
15. Lakhani K, Constantinovici N, Purcell WM, Fernando R, Hardiman P. Inter- nal carotid artery haemodynamics in women with polycystic ovaries. Clin Sci (Lond). 2000;98(6):661-5.
16. Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens. 2002;20(2):159-69.
17. Talbott EO, Zborowski JV, Boudreaux MY, McHugh-Pemu KP, Sutton-Tyrrell K, Guzick DS. The relationship between C-reactive protein and carotid intima-media wall thickness in middle-aged women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2004;89(12):6061-7.
18. Lakhani K, Seifalian AM, Hardiman P. Impaired carotid viscoelastic pro- perties in women with polycystic ovaries. Circulation. 2002;106(1):81-5.
19. Talbott EO, Guzick DS, Sutton-Tyrrell K, McHugh-Pemu KP, Zborowski JV, Remsberg KE, et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol. 2000;20(11):2414-21.
20. Hughan KS, Tfayli H, Warren-Ulanch JG, Barinas-Mitchell E, Arslanian SA. Early Biomarkers of Subclinical Atherosclerosis in Obese Adolescent Girls with Polycystic Ovary Syndrome. J Pediatr. 2016;168:104-11 e1.