Cerebrovascular hemodynamics and cardiac biomarkers in multiple sclerosis: A case-control study

Cerebral blood flow is reduced in multiple sclerosis (MS), potentially due to a partially understood vascular component. Individuals with MS also have a higher cardiovascular disease burden than the general population. We aimed to characterize and compare subclinical vascular disease and thrombophilia in individuals with MS versus healthy controls.

In this cross-sectional study, 60 individuals with MS and 60 age-and sex-matched controls underwent clinical evaluation, carotid and transcranial Doppler ultrasound, brachial artery flow-mediated dilation (FMD), and transthoracic echocardiography (TTE) and laboratory testing, including N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement. Thrombophilia was assessed via laboratory testing for acquired coagulation disorders. Associations of vascular (ICA and MCA PI, RI, CIMT, FMD) and cardiac (NT-proBNP, LVEF) parameters with Expanded Disability Status Scale (EDSS), MS subtype, and disease duration were examined using correlation and regression analyses adjusted for age, sex, and vascular risk factors.

Individuals with MS showed significantly higher internal carotid artery pulsatility index (ICA PI ≥1.0; OR = 5.66, 95% CI 2.21-14.47, p < 0.001). No significant differences were observed in carotid atherosclerosis, endothelial function, or thrombophilia between groups. NT-proBNP levels were markedly higher in secondary progressive MS (SPMS) compared with relapsing-remitting MS (RRMS) (median [p25-p75]: 322 [188-396] vs. 49.5 [24.8-80.0] pg/mL, p = 0.025). No associations were found between vascular or cardiac parameters and disease duration and EDSS.

Individuals with MS exhibit higher ICA PI compared with healthy controls, suggesting subtle subclinical alterations in cerebrovascular hemodynamics independent of traditional vascular risk factors or treatment status. Elevated NT-proBNP in SPMS may indicate mild cardiac strain associated with advanced disease stages. While these findings support the presence of vascular and cardiac involvement in MS, longitudinal studies are warranted to clarify causality and their potential role as biomarkers of disease progression.