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Large artery stiffness and carotid flow pulsatility in stroke survivors

Wohlfahrt, Petera,b,c; Krajcoviechova, Alenaa; Jozifova, Mariea; Mayer, Ottod; Vanek, Jirid; Filipovsky, Jand; Laurent, Stephanee; Cifkova, Renataa,b,f

doi: 10.1097/HJH.0000000000000137
ORIGINAL PAPERS: Stroke
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Objective: Aortic stiffness is increased in lacunar stroke. The precise mechanism linking aortic stiffness to symptomatic lacunar stroke is not well understood. The aim of this study was to compare the effects of aortic stiffness, carotid stiffness, central blood pressure, and cerebrovascular resistance on carotid flow pulsatility according to stroke subtype.

Methods: Two hundred and one consecutive patients were examined 13 months after hospitalization for their first-ever ischemic stroke. The stroke subtype was classified using the Causative Classification of Stroke System. Carotid–femoral pulse wave velocity (PWV) was used as a measure of aortic stiffness. Common carotid flow pulsatility was expressed as resistive index. Central blood pressure was measured using applanation tonometry.

Results: Complete data were available for 174 patients (mean age… 67 ± 10 years, 64% men). In patients with lacunar stroke, aortic PWV was higher (13.11 ± 2.74 m/s) than in individuals with large artery atherosclerosis (9.98 ± 1.87 m/s, P <0.001), cardioembolic (11.31 ± 3.18 m/s, P = 0.04) or cryptogenic stroke (11.13 ± 3.2 m/s, P = 0.01). Similarly, central SBP and resistive index were higher in patients with lacunar stroke (145 ± 23 mmHg and 0.80 ± 0.04, respectively) than those with large artery atherosclerosis (128 ± 18 mmHg, P <0.01 and 0.74 ± 0.07, P <0.01, respectively) or cryptogenic stroke (132 ± 18 mmHg, P <0.01 and 0.76 ± 0.07, P <0.05, respectively). In multivariate analysis, aortic stiffness and central pulse pressure were the main determinants of resistive index independent of stroke subtype.

Conclusion: Our results suggest that aortic stiffening, by reducing the buffering function of the aorta and thereby increasing the transmission of pressure and flow pulsatility into the cerebral arterioles, may contribute to the pathogenesis of lacunar stroke.

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aCenter for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague

bInternational Clinical Research Center, St Ann's University Hospital, Brno

cDepartment of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague

d2nd Department of Internal Medicine, Charles University, Center for Hypertension, Pilsen, Czech Republic

eDepartment of Pharmacology, Georges Pompidou European Hospital, INSERM U970 and Paris University Descartes, Paris, France

fDepartment of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague, Czech Republic

Correspondence to Peter Wohlfahrt, MD, Center for Cardiovascular Prevention, Thomayer Hospital, Videnska 800, 140 59 Prague 4, Czech Republic. Tel: +420 261 083 694; fax: +420 261 083 821; e-mail: wohlfp@gmail.com

Abbreviations: ΔA, stroke change in lumen area; ΔP, local pulse pressure; A, diastolic lumen area; BP, blood pressure; CAEM, cardioembolism; CCA, common carotid artery; CCS, Causative Classification of Stroke System; Cdist, carotid distensibility; CVR, cerebrovascular resistance; CWS, circumferential wall stress; EDV, end-diastolic velocity; ID, internal diameter of the common carotid artery; IMT, intima–media thickness; LAA, large artery atherosclerosis; MBP, mean blood pressure; MFV, mean flow velocity; PSV, peak systolic velocity; PWV, pulse wave velocity

Received 10 September, 2013

Revised 15 January, 2014

Accepted 15 January, 2014

The results were partly presented as an oral presentation at the 23rd European Meeting on Hypertension & Cardiovascular Protection, held in Milan on 14–17 June 2013.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

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