The distribution of cerebral microbleeds determines their association with arterial stiffness in non‐cardioembolic acute stroke patients

Song, Tae‐Jin; Kim, J.; Kim, Y. D.; Nam, Hyo Suk; Lee, Hye Sun; Nam, Chung Mo; Heo, Ji Hoe

doi:10.1111/ene.12332

Cited by 44 publications

(33 citation statements)

References 29 publications

(53 reference statements)

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“…We are aware of several previous studies that examined the association of brachial-ankle or carotid-femoral pulse wave velocity with the presence of CMBs. 10,17,18 Those results based on indirect measures of regional arterial stiffness over a certain arterial length, are consistent with our results. More recently, local carotid stiffness measures have been reported to be associated with larger volume of white matter hyperintensities.…”

Section: Discussionsupporting

confidence: 91%

Carotid Arterial Stiffness and Risk of Incident Cerebral Microbleeds in Older People

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Mitchell

Bots

et al. 2015

ATVB

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Objective Age and high blood pressure are major risk factors for cerebral microbleeds (CMBs). However, the underlying mechanisms remain unclear and arterial stiffness may be important. We investigated whether carotid arterial stiffness is associated with incidence and location of CMBs. Approach and Results In the prospective, population-based AGES-Reykjavik study, 2,512 participants aged 66–93 years underwent a baseline brain MRI examination and carotid ultrasound in 2002–2006, and returned for a repeat brain MRI in 2007–2011. Common carotid arterial stiffness was assessed using a standardized protocol and expressed as carotid arterial strain (CAS), distensibility coefficient (DC) and Young’s elastic modulus (YEM). Modified poisson regression was applied to relate carotid arterial stiffness parameters to CMBs incidence. During a mean follow-up of 5.2 years, 463 people (18.4%) developed new CMBs, of whom 292 had CMBs restricted to lobar regions and 171 had CMBs in a deep or infratentorial region. After adjusting for age, sex and follow-up interval, arterial stiffness measures were associated with incident CMBs (Risk ratio [RR] per SD decrease in CAS, 1.11 [95%CI, 1.01–1.21]; per SD decrease in natural log-transformed DC, 1.14[1.05–1.24]; per SD increase in natural log-transformed YEM, 1.13[1.04–1.23]). These measures were also significantly associated with incident deep CMBs (1.18[1.02–1.37]; 1.24[1.08–1.42]; 1.23[1.07–1.42]) but not with lobar CMBs. When further adjusted for blood pressure and other baseline vascular risk factors, carotid plaque, prevalent CMBs, subcortical infarcts and white matter hyperintensities, the associations persisted. Conclusions Our findings support the hypothesis that localized increases in carotid arterial stiffness may contribute to the development of CMBs, especially in a deep location atttributable to hypertension.

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Section: Discussionsupporting

confidence: 91%

Carotid Arterial Stiffness and Risk of Incident Cerebral Microbleeds in Older People

Ding

Mitchell

Bots

et al. 2015

ATVB

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“…The extent of white-matter hyperintensities was determined on the FLAIR images for the periventricular white matter or deep white matter according to the Fazekas scoring system 12. A Fazekas score of 3 in periventricular white matter or ≥2 in deep white matter was considered to indicate HWHs.…”

Section: Methodsmentioning

confidence: 99%

Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

et al. 2017

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Background and PurposeThe recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke.MethodsIn total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models.ResultsCMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67).ConclusionsThe total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.

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“…Although it has been shown that microbleeds in the pallidum and putamen are strongly associated with hypertension, the association with aortic stiffening is less obvious. Recent larger studies assessing the association between aortic stiffening and the presence of microbleeds demonstrate a slight association with increased vascular stiffening, 70, 71 although not all studies support this finding. 62, 63 …”

Section: Mri Of Brain Small Vessel Disease and Aortic Functionmentioning

confidence: 97%

Magnetic Resonance Imaging of Cardiovascular Function and the Brain

et al. 2017

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The proximal aorta acts as a coupling device between heart and brain perfusion, modulating the amount of pressure and flow pulsatility transmitted into the cerebral microcirculation. Stiffening of the proximal aorta is strongly associated with age and hypertension. The detrimental effects of aortic stiffening may result in brain damage as well as heart failure. The resulting cerebral small vessel disease and heart failure may contribute to early cognitive decline and (vascular) dementia. This pathophysiological sequence of events underscores the role of cardiovascular disease as a contributory mechanism in causing cognitive decline and dementia and potentially may provide a starting point for prevention and/or treatment. Magnetic resonance imaging (MRI) is well suited to assess the function of the proximal aorta and the left ventricle (e.g. aortic arch pulse wave velocity and distensibility) as well as the various early and late manifestations of cerebral small vessel disease (e.g. microbleeds and white matter hyperintensities in strategically important regions of the brain). Specialized MRI techniques are explored for diagnosing preclinical changes in white matter integrity or brain microvascular pulsatility. This review discusses the potential role of MRI for evaluating the pathophysiology of proximal aortic function with aging and the interaction between aortic function and brain perfusion, as a contributing mechanism to cerebral small vessel disease, resulting in early cognitive decline and vascular dementia.

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The distribution of cerebral microbleeds determines their association with arterial stiffness in non‐cardioembolic acute stroke patients

Abstract: Arterial stiffness was independently associated with deep or infratentorial CMBs but not lobar CMBs. These findings suggest a pathophysiological association between arterial stiffness and CMBs in the deep or infratentorial region.

Cited by 44 publications

References 29 publications

Carotid Arterial Stiffness and Risk of Incident Cerebral Microbleeds in Older People

Carotid Arterial Stiffness and Risk of Incident Cerebral Microbleeds in Older People

Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

Magnetic Resonance Imaging of Cardiovascular Function and the Brain

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