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Tamura Y, Shimoji K, Ishikawa J, Matsuo Y, Watanabe S, Takahashi H, Zen S, Tachibana A, Omura T, Kodera R, Oba K, Toyoshima K, Chiba Y, Tokumaru AM, Araki A. Subclinical Atherosclerosis, Vascular Risk Factors, and White Matter Alterations in Diffusion Tensor Imaging Findings of Older Adults With Cardiometabolic Diseases. Front Aging Neurosci 2021; 13:712385. [PMID: 34489681 PMCID: PMC8417784 DOI: 10.3389/fnagi.2021.712385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
White matter abnormalities may reflect cerebral microvessel disease. Diffusion tensor imaging (DTI) can help detect early changes in white matter integrity in each tract. However, studies investigating the relationship between subclinical atherosclerosis markers and white matter alterations in DTI findings are limited. This study aimed to examine associations between cardiovascular risk factors and indices of subclinical atherosclerosis-ankle brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and carotid artery intima-media thickness (IMT)-and altered white matter integrity in older patients. A total of 224 patients (aged ≥65 years) with cardiometabolic disease who underwent magnetic resonance imaging (MRI) and either plethysmography or cervical ultrasound at the start of the 3-year observational study period were included in this study. We measured fractional anisotropy (FA) and mean diffusivity (MD), which are indices of white matter integrity in seven white matter tracts. In a univariate analysis, lower ABI and higher baPWV values were associated with FA or MD abnormalities in several tracts, whereas IMT was scarcely associated with such change. In addition, high blood pressure and glycoalbumin/glycohemoglobin ratio (GA/HbA1c) and low body mass index (BMI) and triglyceride (TG) levels were associated with FA or MD abnormalities. In a multivariate analysis adjusted for age, sex, BMI, diastolic blood pressure, TG, and GA/HbA1c, the associations between ABI and FA or MD remained in all of either side of the following tracts: anterior thalamic radiation, forceps minor, inferior frontooccipital fasciculus (p < 0.001 for all) and superior longitudinal fasciculus (SLF; p < 0.05), whereas most of those between baPWV and FA or MD disappeared except for SLF (p < 0.05). These results indicate that low ABI could be an indicator of white matter abnormalities.
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Affiliation(s)
- Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yoshinori Matsuo
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - So Watanabe
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hisae Takahashi
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Shugo Zen
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya Tachibana
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Takuya Omura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kazuhito Oba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kenji Toyoshima
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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Li T, Wu XJ, Chen XM, Wang SB, Liu KD, Xing YQ. Ankle-brachial index and brachial-ankle pulse wave velocity are risk factors for ischemic stroke in patients with Type 2 diabetes. Neural Regen Res 2017; 12:1853-1859. [PMID: 29239331 PMCID: PMC5745839 DOI: 10.4103/1673-5374.219046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity (BaPWV) and ankle-brachial index (ABI) are known to be associated with ischemic cardiovascular and cerebrovascular diseases, whether these measures predict the risk of ischemic cerebrovascular disease in diabetic patients remains unclear. 117 patients with type 2 diabetes were enrolled in this study. According to the results of head magnetic resonance imaging, the patients were divided into a diabetes-only group (n = 55) and a diabetes and ischemic stroke group (n = 62). We then performed ABI and BaPWV examinations for all patients. Compared with the diabetes-only group, we found decreased ABI and increased BaPWV in the diabetes and ischemic stroke group. Multivariate logistic regression analyses revealed that BaPWV and ABI were risk factors for ischemic stroke in patients with type 2 diabetes. Our findings indicate that decreased ABI and increased BaPWV are objective indicators of increased risk of ischemic stroke in patients with type 2 diabetes.
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Affiliation(s)
- Ting Li
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiu-Juan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiao-Min Chen
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Si-Bo Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Kang-Ding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ying-Qi Xing
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China
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Naito H, Naka H, Kobayashi M, Kanaya Y, Naito K, Kurashige T, Tokinobu H, Matsumoto M. Prevalences of Peripheral Arterial Disease Diagnosed by Computed Tomography Angiography in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:1128-1134. [PMID: 26915602 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/24/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Few studies have examined the prevalence of peripheral arterial disease (PAD) with the use of computed tomography angiography (CTA) in patients with acute ischemic stroke (AIS), although several reports have examined its prevalence using an ankle brachial index (ABI). We aimed to determine the prevalence of PAD indicated by CTA in patients with AIS and to clarify the prevalence of PAD in each clinical ischemic stroke subtype. METHODS We included 199 consecutive patients with AIS admitted to our hospital and divided them into PAD and non-PAD groups according to the CTA findings. RESULTS Of the 199 patients, 40 (20.1%) had PAD; 27 (67.5%) of the PAD patients were asymptomatic. The prevalence of abnormal ABI (≤.9) was 12.2%. Patients with PAD were older (78.3 ± 10.2 versus 71.5 ± 10.9, P <.001) and had a significantly lower ABI value (.89 ± .24 versus 1.15 ± .09, P <.001) and higher prevalence of diabetes mellitus (50.0% versus 31.4%, P = .028), atrial fibrillation (40.0% versus 16.4%, P = .001), coronary artery disease (32.5% versus 8.2%, P <.001), and intracranial arterial stenosis (47.5% versus 28.9%, P = .025) than patients without PAD. The prevalence of cerebral microbleeds was not different between patients with PAD and those without PAD (25.6% versus 25.4%, P = .985). The prevalence of PAD among ischemic stroke subtypes was highest in patients with cardioembolic infarction (40.5%). CONCLUSIONS Almost one fourth of the AIS patients examined had PAD on CTA. Cardioembolic infarction patients showed the highest prevalence of PAD among the clinical ischemic subtypes, suggesting the coexistence of atheromatous diseases and atrial fibrillation.
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Affiliation(s)
- Hiroyuki Naito
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Hiromitsu Naka
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Megumi Kobayashi
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yuhei Kanaya
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Neurology, National Hospital Organization Kure Medical Center, Hiroshima, Japan
| | - Kasane Naito
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takashi Kurashige
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Neurology, Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Hiroshi Tokinobu
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Hao Z, Yang C, Tao W, Liu M. Prognostic implications of the Ankle Brachial Index in patients with acute ischemic stroke: A meta-analysis. Expert Rev Neurother 2016; 16:351-8. [PMID: 26786967 DOI: 10.1586/14737175.2016.1142875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The ankle brachial index (ABI) is recognized as a marker of atherosclerotic disease. The detection of ABI may improve the risk stratification. METHODS We systematically searched Pubmed and Embase (from the earliest date to October 2015) for studies evaluating the prognostic value of ABI in patients with acute ischemic stroke. Stroke or cardiovascular events, mortality and functional outcomes were analyzed. RESULTS Seventeen studies, containing 9404 patients, were included. The mean age of participants in each study ranged from 64 to 79 years. The prevalence of low ABI varied from 7.4% to 40.5%. In this quantitative analysis, we found that low ABI increased the risk of composite outcomes (myocardial infarction or stroke or mortality), disability and mortality. CONCLUSION The detection of ABI may help to identify high-risk patients for secondary stroke prevention.
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Affiliation(s)
- Zilong Hao
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Chunsong Yang
- b Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children , Sichuan University , Chengdu , China
| | - Wendan Tao
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Ming Liu
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
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