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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Assessment of endothelial function in patients with initial manifestations of chronic cerebral ischemia
Maryna A Trishchynska1, Maryna V Globa1, Vasyl V Orzheshkovskyi1
1Shupyk National Medical Academy Of Postgraduate Education, Kyiv, Ukraine
Insights
Endothelial dysfunction, indicated by reduced flow-mediated dilatation (FMD), is linked to brain changes and risk factors like hypertension in patients with early chronic cerebral ischemia (CCI). This highlights the importance of assessing endothelial function for cerebrovascular disease prevention.
Area of Science:
- Neurology
- Vascular Biology
- Cardiology
Background:
- Cerebrovascular diseases are rising in Ukraine, driven by increased prevalence of vascular risk factors.
- Early detection and prevention of cerebrovascular diseases are crucial due to the early onset and clustering of risk factors.
- Endothelial vasomotor function is a key factor in the early stages of chronic cerebral ischemia (CCI).
Purpose of the Study:
- To investigate endothelial vasomotor function in patients presenting with initial symptoms of CCI.
- To correlate endothelial function markers with structural brain changes and vascular risk factors.
Main Methods:
- Included 260 patients with initial CCI symptoms and 30 controls.
- Assessed flow-mediated dilatation (FMD) via brachial artery compression test and measured endothelin-1 and nitrite levels.
- Utilized brain MRI to categorize patients based on structural changes and cerebral atrophy.
Main Results:
- Significantly lower FMD indices were observed in patients with structural brain damage compared to controls (p<0.001).
- FMD index decreased with an increasing number of vascular risk factors (p<0.05) and was associated with arterial hypertension (p<0.05).
- Thickened intima-media complex (>0.9 mm) and biochemical markers of endothelial dysfunction (elevated endothelin-1, decreased nitrite) were linked to reduced FMD (p<0.001).
Conclusions:
- Endothelial dysfunction, assessed by FMD, is associated with structural brain damage in CCI patients.
- Arterial hypertension and intima-media thickening are linked to impaired endothelial function.
- Biochemical markers of endothelial dysfunction correlate with reduced FMD, underscoring their role in cerebrovascular disease.
Introduction:
Over the last decade, the number of patients with cerebrovascular diseases in Ukraine has grown by 1.5 times. This negative trend is based on the significant increase of vascular risk factors - arterial hypertension, dyslipidemia, sedentary lifestyle, excessive weight/obesity, diabetes mellitus, tobacco smoking, etc. - prevalence among the population of the country, their early development and combination of several vascular risk factors, which makes prevention of cerebrovascular diseases at their early stages a priority. The aim: Study of endothelial vasomotor function in patients with initial symptoms of chronic cerebral ischemia.
Material And Methods:
The study included 260 patients of the main group (mean age 50.6±70.9) with initial manifestations of CCI and 30 persons of similar age of the control group. All the patients underwent a clinical neurological examination, MRI of the brain, ultrasonography with the establishment of flow-mediated endotelium-dependent dilatation (FMD) index based on the results of brachial artery compression test, as well as laboratory tests of endothelin-1 and nitrite levels. The patients were subdivided into 3 groups based on their MRI of the brain data: without structural changes of the brain (group 1), with initial vascular structural changes (group 2), with initial structural changes and mild cerebral atrophy (group 3).
Results:
Reliable differences of FMD index were established in the groups with different degrees of structural brain damage, and in comparison with the control group (р<0.001). Considerable downward trend of FMD index with increase of the number of existing vascular risk factors (VRF) was identified (p<0.05). An associative link with the presence of arterial hypertension (AH), its degree and FMD index (p<0.05) was established. It was shown that a thickened intima-media complex (ІМC) of common carotid arteries >0.9 mm had a significantly lower predetermination to FMD (р=0,001). Statistically significant lower FMD indices were registered in persons with endothelial vasomotor function disorder according to the biochemical markers: with endothelin level increase and nitrite level decrease (р<0.001).
Conclusions:
An associative link with the presence of endothelial dysfunction according to FMD index were established with different degrees of structural brain damage, with the presence of AH, with ІМC of common carotid arteries >0.9 mm, with endothelial vasomotor function disorder according to the biochemical markers: with endothelin level increase and nitrite level decrease.
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