Proposing arterial stiffness as an alternative way of assessing risk in transient ischaemic attack (TIA) patients

Soram RU Patel, Khalid Ali, Eva Bunting, Emma Bodenham, Jean Timeyin, Chakravarthi Rajkumar

Abstract


Background: The ABCD2 score is a clinical tool currently categorising transient ischaemic attack (TIA) patients as low or high risk. Arterial stiffness, a novel physiological parameter predicting future cardiovascular events, has not been explored in TIA populations.

Methods: The following arterial stiffness parameters were measured in TIA patients aged >40 years: carotid-femoral pulse wave velocity (C-F PWV), carotid-radial pulse wave velocity (C-R PWV) using Complior® and central and peripheral blood pressure (BP) using Arteriograph®. Nocturnal BP dipping profiles were measured using 24-h ambulatory blood pressure monitoring. TIA participants were age- and gender-matched with healthy subjects to compare arterial stiffness and BP profiles.

Results: Twenty-four TIA patients, 50% male, of mean±SD age 70±10.1 years were recruited to the study. Mean±SD C-F PWV was 11.5±3.18 m/s and C-R PWV was 10.8±1.26 m/s. Published normative data for healthy age- and gender-matched subjects are C-F PWV 10.9 m/s and C-R PWV 10.1 m/s. Our TIA patients had higher central (130 mmHg) than peripheral BP (128 mmHg) compared with healthy subjects in whom central BP is 10–15 mmHg lower than peripheral BP. Thirty-eight percent of TIA patients lacked nocturnal dipping compared with 19% of healthy subjects.

Conclusions: In our TIA cohort we found increased arterial stiffness measurements compared to healthy subjects.

Keywords


stroke, TIA, arterial stiffness, blood pressure, ambulatory, dippers

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References


Truelsen T, Begg S, Mathers C. The global burden of cerebrovascular disease. Geneva: World Health Organisation; 2000.

Hippisley-Cox J, Pringle M, Ryan R. Stroke: prevalence, incidence and care in general practices 2002 to 2004. Final report to the national stroke audit team. London: Royal College of Physicians; 2004.

Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement. Stroke 2009;40(6):2276-93. http://dx.doi.org/10.1161/STROKEAHA.108.192218

Rothwell PM, Warlow CP. Timing of TIAs preceding stroke: time window for prevention is very short. Neurology 2005;64:817-20. http://dx.doi.org/10.1212/01.WNL.0000152985.32732.EE

vanWijk I, Kappelle LJ, van Gijn J, et al. Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet 2005;365(9477):2098-104. http://dx.doi.org/10.1016/S0140-6736(05)66734-7

Wardlaw JM, Brazzelli M, Chappell FM, et al. ABCD2 score and secondary stroke prevention: meta-analysis and effect per 1000 patients triaged. Neurology 2015;85(4):373-80. http://dx.doi.org/10.1212/WNL.0000000000001780

Johnston SC, Rothwell PM, Huynh-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischemic attack. Lancet 2007;369:283-92. http://dx.doi.org/10.1016/S0140-6736(07)60150-0

Bhatt A, Jani V. The ABCD and ABCD2 scores and the risk of stroke following a TIA: a narrative review. ISRN Neurol 2011:518621. http://dx.doi.org/10.5402/2011/518621

Rothwell PM. Lack of epidemiological data on secondary stroke prevention. Lancet 2005;4(9):518-19. http://dx.doi.org/10.1016/S1474-4422(05)70148-4

Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37(5):1236-41. http://dx.doi.org/10.1161/01.HYP.37.5.1236

Mitchell GF, Hwang SJ, Vasan RS, et al. Arterial stiffness and cardiovascular events: the Framingham heart study. Circulation 2010;121(4):505-11. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.886655

Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 2002;39(1):10-5. http://dx.doi.org/10.1161/hy0102.099031

Maldonado J, Pereira T, Polonia J, et al. Arterial stiffness predicts cardiovascular outcome in a low-to-moderate cardiovascular risk population: the EDIVA (estudo de distensibilidade vascular) project. J Hypertens 2011;29(4):669-75. http://dx.doi.org/10.1097/HJH.0b013e3283432063

Mattace-Raso FU, van der Cammen TJ, Hofman A, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study. Circulation 2006;113(5):657-63. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.555235

Kingwell BA, Waddell TK, Medley TL, et al. Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. J Am Coll Cardiol 2002;40(4):773-9. http://dx.doi.org/10.1016/S0735-1097(02)02009-0

Wilkinson IB, McEniery CM, Cockcroft JR. Pulse waveform analysis and arterial stiffness: realism can replace evangelism and scepticism. J Hypertens 2005;23(1):213. http://dx.doi.org/10.1097/00004872-200501000-00032

Gladdish S, Manawadu D, Banya W, et al. Repeatability of non-invasive measurement of intracerebral pulse wave velocity using transcranial Doppler. Clin Sci (Lond) 2005;108(5):433-9. http://dx.doi.org/10.1042/CS20040251

Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical outcomes. Eur Heart J 2006;27(21):2588-605. http://dx.doi.org/10.1093/eurheartj/ehl254

Scuteri A, Sgorbini L, Leggio F, Brancati AM. Aortic correlates of clinical markers of large artery structure and function. Aging Clin Exp Res 2006;18(5):452-61. http://dx.doi.org/10.1007/BF03324843

Karamanoglu M, O'Rourke MF, Avolio AP, Kelly RP. An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. Eur Heart J 1993;14(2):160-7. http://dx.doi.org/10.1093/eurheartj/14.2.160

McEniery CM, Yasmin, McDonnell B, et al. Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff Collaborative Trial II. Hypertension 2008;51(6):1476-82. http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.105445

Roman MJ, Devereux RB, Kizer JR, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the strong heart study. Hypertension 2007;50(1):197-203. http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.089078

Li Y, Wang JG, Dolan E, et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 2006; 47(3):359-64. http://dx.doi.org/10.1161/01.HYP.0000200695.34024.4c

Dolan E, Li Y, Dolan E, et al. Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in the Dublin Outcome Study. Hypertension 2006;47(3):365-70. http://dx.doi.org/10.1161/01.HYP.0000200699.74641.c5

Sturrock ND, George E, Pound N, et al. Non-dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus. Diabet Med 2000;17(5):360-4. http://dx.doi.org/10.1046/j.1464-5491.2000.00284.x

Ramsay I, Fantin F, Zamboni M, et al. Prevalence of unrecognised metabolic syndrome in the healthy elderly population–Brighton and Verona seniors study (BRAVES). Age Ageing 2013;42(s2):ii26-27.

Mattace-Raso F, Hofman A, Verwoert G, et al. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'. Eur Heart J 2010;31(19):2338-50. http://dx.doi.org/10.1093/eurheartj/ehq165

Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the conduit artery function evaluation (CAFE) study. Circulation 2006;113(9):1213-25. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595496

O'Brien E. Ambulatory blood pressure monitoring in the management of hypertension. Heart 2003;89(5):571-6. http://dx.doi.org/10.1136/heart.89.5.571

Sacco RL, Benjamin EJ, Broderick JP, et al. American Heart Association Prevention Conference IV. Prevention and Rehabilitation of Stroke. Risk factors. Stroke 1997;28(7):1507-17.




DOI: https://doi.org/10.15277/bjd.2016.057

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