Homocysteine and pulsatility index in lacunar infarction

To evaluate an association between plasma concentration of total homocysteine (tHcy) and pulsatility indexes (PIs) of cerebral arteries in patients with lacunar infarction (LI), comparing control subjects.

Consecutive patients referred to a neurovascular ultrasound laboratory were evaluated from March 2007 to February 2008. LI was determined by high signal intensity lesion (<15mm) in brain MRI and PI was defined as (peak-systolic velocity-end-diastolic velocity)/mean flow velocity as recommended. Plasma tHcy was categorized into tertiles and analyzed for an association with PIs.

83 patients with LI and 135 control subjects were analyzed. The patients with LI showed significantly lower peak-systolic, end-diastolic, and mean flow velocities than the control group, especially in posterior circulatory beds. The group with LI showed independent associations between the higher tertiles of tHcy and the graded and linear increases of PIs, even after adjusted for potential confounders including vascular risk factors, but not in the control group. Interaction terms were significant in both the right middle cerebral artery and basilar artery, and borderline significant in the left vertebral artery (p=0.040, 0.022, 0.055, respectively).

Increased plasma tHcy was significantly and independently associated with increased cerebral arterial resistance in the patients with LI.