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Blood pressure undulation of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis. J Hypertens 2022; 40:749-757. [PMID: 34980864 DOI: 10.1097/hjh.0000000000003070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence suggests that patients with higher blood pressure variability (BPV) have a higher risk for stroke but the relationship between BPV and stroke outcomes is unknown in those who underwent intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). The objective of this study is to investigate the association among BPV, BP values and stroke outcomes. METHODS A retrospective analysis of about 510 consecutive thrombolysis cases for AIS from January 2015 to March 2019 in a single-center database were done. Then, these patients were followed-up for 3 months. We used univariate and multivariable models to evaluate the relationship between mean BP values, BPV and the risk of stroke outcomes from prior IVT to 72 h after IVT. Meanwhile, we also used COX regression to assess the hazard ratios of stroke outcomes with BPV within 3 months. Furthermore, we tested the effect of BP level at various time-points (prior to IVT and at 0, 2, 4, 8, 12, 24, 48 and 72 h after IVT) on development of postthrombolytic stroke outcomes. RESULTS Higher BPV from prior IVT to 72 h after IVT was associated with higher risk of stroke outcomes within 3 months [SBPV of recurrent stroke: odds ratios (OR) = 5.298, 95% confidence interval (CI) 1.339-10.968, P = 0.018; DBPV of recurrent stroke: OR = 6.397, 95% CI 1.576-25.958, P = 0.009, respectively]. In addition, patients with recurrent stroke had significantly higher mean SBP (OR=1.037, 95% CI 1.006-1.069, P = 0.019). Furthermore, higher BP at different time points were associated with greater risk of recurrent stroke from prior IVT to 72 h after IVT. CONCLUSION Higher BPV and SBP from prior IVT to 72 h after IVT was associated with higher risk of stroke outcomes within 3 months.
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Tsai WC, Lee WH, Tsai HR, Huang MS. Carotid vascular strain predicts cardiovascular events in patients with hypertension. Echocardiography 2021; 38:1900-1906. [PMID: 34713483 DOI: 10.1111/echo.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/10/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We aim to investigate prognostic effects of carotid strain (CS) and strain rate (CSR) in hypertension. METHODS We prospectively recruited 120 patients being treated for hypertension (65.8 ± 11.8 years, 58% male) in this observational study. Peak circumferential CS and peak CSR after ejection were identified using two-dimensional speckle tracking ultrasound. Major cardiovascular events were any admission for stroke, acute coronary syndrome, and heart failure. RESULTS After a mean follow-up period of 63.6 ± 14.5 months, 14 (12%) patients had cardiovascular events. Age (75.3 ± 9.2 vs 64.6 ± 11.6 years; p = 0.001), systolic blood pressure (131.8 ± 15.5 vs 143.1 ± 16.6 mm Hg; p = 0.021), diastolic blood pressure (74.6 ±11.4 vs 82.1 ± 12.2 mm Hg; p = 0.039), use of diuretics (71 vs 92%; p = 0.014), carotid CS (2.17 ± 1.02 vs 3.28 ± 1.14 %; p = 0.001), and CSR (.28 ± .17 vs .51 ± .18 1/s; p < 0.001) were significantly different between the patients who did and did not reach the end-points. Multivariate Cox regression analysis controlling for age, systolic blood pressure, diastolic blood pressure, and use of diuretics showed that CS (HR .425, 95%CI .223-.811, p = 0.009) and CSR (HR .001, 95%CI .000-.072, p = 0.001) were independent predictors for cardiovascular events. CONCLUSION In conclusions, decreased CS and CSR were associated with cardiovascular events in hypertension.
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Affiliation(s)
- Wei-Chuan Tsai
- Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
| | - Wen-Huang Lee
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
| | - Huey-Ru Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan.,Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan
| | - Mu-Shiang Huang
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
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Tjan A, Widiana IGR, Martadiani ED, Ayusta IMD, Asih MW, Sitanggang FP. Carotid artery stiffness measured by strain elastography ultrasound is a stroke risk factor. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Iino H, Okano T, Daimon M, Sasaki K, Chigira M, Nakao T, Mizuno Y, Yamazaki T, Kurano M, Yatomi Y, Sumi Y, Sasano T, Miyata T. Usefulness of Carotid Arterial Strain Values for Evaluating the Arteriosclerosis. J Atheroscler Thromb 2018; 26:476-487. [PMID: 30344204 PMCID: PMC6514172 DOI: 10.5551/jat.45591] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIM We investigated the clinical usefulness of carotid arterial strain and the strain rate for evaluating the progression of arteriosclerosis measured using a two-dimensional speckle-tracking method in carotid ultrasonography. METHODS We enrolled 259 participants (age: 64±12 years; men: 149; women: 110) in this retrospective analysis. The circumferential strain and the strain rate were measured in bilateral common carotid arteries, and the lowest values were used for the analyses. To assess the characteristics of strain and the strain rate, we investigated the associations between the strain values and gender, age, body mass index (BMI), blood pressure (BP), and the presence of hypertension, diabetes mellitus, and hyperlipidemia. We also examined the explanatory factors for the strain values using clinical parameters along with the intima-media thickness (IMT), the ankle brachial index (ABI), and the cardio-ankle vascular index (CAVI) as possible candidates. Finally, we investigated whether the strain values might be an independent predictor for vascular diseases using multivariate logistic regression analyses. RESULTS The carotid circumferential strain and the strain rate were significantly correlated with age, IMT, and the CAVI, but not with the BMI, BP, or ABI. Strain and the strain rates were lower in participants with hypertension or cerebrovascular disease and were selected as significant predictive factors for the presence of cerebrovascular diseases, together with diabetes and the CAVI. CONCLUSIONS Strain and the strain rate of carotid arteries, which could represent local arterial stiffness, might be associated with atherosclerosis and could possibly be used to predict cerebrovascular disease.
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Affiliation(s)
- Hiroko Iino
- Department of Clinical Laboratory, The University of Tokyo Hospital.,Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University
| | - Tomoko Okano
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masao Daimon
- Department of Clinical Laboratory, The University of Tokyo Hospital.,Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Kazuno Sasaki
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Mayumi Chigira
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Tomoko Nakao
- Department of Clinical Laboratory, The University of Tokyo Hospital.,Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Tsutomu Yamazaki
- Innovation & Research Support Center, International University of Health and Welfare
| | - Makoto Kurano
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Yuki Sumi
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University.,Department of Cardiovascular Physiology, Tokyo Medical and Dental University
| | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
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5
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Yoon JH, Han D, Kim S, Cho IJ, Sung JM, Lee J, Ryoo H, Shim CY, Hong GR, Chang HJ. Assessment of multidirectional movements of the common carotid artery in atherothrombotic stroke using dimensional speckle tracking carotid ultrasonography: A prospective, controlled cohort study. Echocardiography 2018; 35:957-964. [PMID: 29600550 DOI: 10.1111/echo.13881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM We aimed to explore the relevance of multidirectional movements of the common carotid artery in atherothrombotic stroke. METHODS AND RESULTS We prospectively enrolled 69 patients with atherothrombotic stroke (stroke group) and 69 age-matched and sex-matched controls (control group) who underwent carotid ultrasonography. Based on the speckle tracking technique, circumferential and radial movements of the common carotid artery were analyzed from transverse and longitudinal B-mode images of the common carotid artery. Peak longitudinal and radial displacements, strain, and strain rate were measured. Mean age of the overall population was 64 ± 11 years, and 57% (78 patients) were men. In the transverse image, circumferential strain was significantly lower in the stroke group than in the control group (5.6 ± 1.6 vs 4.2 ± 1.7, P < .001). In multivariate logistic regression analysis, circumferential strain was independently associated with stroke (odds ratio: 0.60, P = .001). Compared with conventional risk factors, as well as carotid intima-media thickness and carotid plaque, the addition of a strain parameter appeared to improve discrimination of a stroke event (area under the receiver operating characteristic curve: 0.65 and 0.75 vs 0.84, respectively; P < .05 for both). CONCLUSIONS Circumferential strain of the common carotid artery might serve as a novel surrogate marker of atherothrombotic stroke. Multidirectional strain imaging of the common carotid artery may provide more information than conventional carotid ultrasonography and identify clinical risk factors for risk stratification of an acute stroke event.
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Affiliation(s)
- Ji Hyun Yoon
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Donghee Han
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Sujin Kim
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - In-Jeong Cho
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Ji Min Sung
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jinyong Lee
- Medical Imaging Research Group, Samsung Medison, Seoul, Korea
| | - Hojin Ryoo
- Medical Imaging Research Group, Samsung Medison, Seoul, Korea
| | - Chi Young Shim
- Cardiology Division, Department of Internal Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Cardiology Division, Department of Internal Medicine, Seoul, Korea
| | - Hyuk-Jae Chang
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Teixeira R, Monteiro R, Baptista R, Pereira T, Ribeiro MA, Gonçalves A, Cardim N, Gonçalves L. Aortic arch mechanics measured with two-dimensional speckle tracking echocardiography. J Hypertens 2017; 35:1402-1410. [DOI: 10.1097/hjh.0000000000001336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chen Y, Shen F, Liu J, Yang GY. Arterial stiffness and stroke: de-stiffening strategy, a therapeutic target for stroke. Stroke Vasc Neurol 2017; 2:65-72. [PMID: 28959494 PMCID: PMC5600012 DOI: 10.1136/svn-2016-000045] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/30/2016] [Accepted: 01/24/2017] [Indexed: 12/25/2022] Open
Abstract
Stroke is the second leading cause of mortality and morbidity worldwide. Early intervention is of great importance in reducing disease burden. Since the conventional risk factors cannot fully account for the pathogenesis of stroke, it is extremely important to detect useful biomarkers of the vascular disorder for appropriate intervention. Arterial stiffness, a newly recognised reliable feature of arterial structure and function, is demonstrated to be associated with stroke onset and serve as an independent predictor of stroke incidence and poststroke functional outcomes. In this review article, different measurements of arterial stiffness, especially pressure wave velocity, were discussed. We explained the association between arterial stiffness and stroke occurrence by discussing the secondary haemodynamic changes. We reviewed clinical data that support the prediction role of arterial stiffness on stroke. Despite the lack of long-term randomised double-blind controlled therapeutic trials, it is high potential to reduce stroke prevalence through a significant reduction of arterial stiffness (which is called de-stiffening therapy). Pharmacological interventions or lifestyle modification that can influence blood pressure, arterial function or structure in either the short or long term are promising de-stiffening therapies. Here, we summarised different de-stiffening strategies including antihypertension drugs, antihyperlipidaemic agents, chemicals that target arterial remodelling and exercise training. Large and well-designed clinical trials on de-stiffening strategy are needed to testify the prevention effect for stroke. Novel techniques such as modern microscopic imaging and reliable animal models would facilitate the mechanistic analyses in pathophysiology, pharmacology and therapeutics.
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Affiliation(s)
- Yajing Chen
- Department of Neurology, Ruijin Hospital and Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanxia Shen
- Department of Neurology, Ruijin Hospital and Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong Liu
- Department of Neurology, Ruijin Hospital and Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Yuan Yang
- Department of Neurology, Ruijin Hospital and Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Neuroscience and Neuroengineering Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study. Int J Cardiovasc Imaging 2016; 33:509-519. [DOI: 10.1007/s10554-016-1028-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/21/2016] [Indexed: 12/20/2022]
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9
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Teixeira R, Vieira MJ, Gonçalves A, Cardim N, Gonçalves L. Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging 2015; 17:233-46. [DOI: 10.1093/ehjci/jev287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022] Open
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10
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Steinl DC, Kaufmann BA. Ultrasound imaging for risk assessment in atherosclerosis. Int J Mol Sci 2015; 16:9749-69. [PMID: 25938969 PMCID: PMC4463615 DOI: 10.3390/ijms16059749] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 01/28/2023] Open
Abstract
Atherosclerosis and its consequences like acute myocardial infarction or stroke are highly prevalent in western countries, and the incidence of atherosclerosis is rapidly rising in developing countries. Atherosclerosis is a disease that progresses silently over several decades before it results in the aforementioned clinical consequences. Therefore, there is a clinical need for imaging methods to detect the early stages of atherosclerosis and to better risk stratify patients. In this review, we will discuss how ultrasound imaging can contribute to the detection and risk stratification of atherosclerosis by (a) detecting advanced and early plaques; (b) evaluating the biomechanical consequences of atherosclerosis in the vessel wall;
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Affiliation(s)
- David C Steinl
- Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, Basel 4031, Switzerland.
| | - Beat A Kaufmann
- Division of Cardiology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.
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Circumferential vascular strain rate to estimate vascular load in aortic stenosis: a speckle tracking echocardiography study. Int J Cardiovasc Imaging 2015; 31:681-9. [DOI: 10.1007/s10554-015-0597-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/17/2015] [Indexed: 10/24/2022]
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12
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Tsai WC, Sun YT, Liu YW, Ho CS, Chen JY, Wang MC, Tsai LM. Response to "vascular mechanics and stroke-a critical appraisal: study the arteries but do not forget the flow". Am J Hypertens 2013; 26:947. [PMID: 23748221 DOI: 10.1093/ajh/hpt068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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