Impaired cerebrovascular reactivity as a risk marker for first-ever lacunar infarction: A case-control study.
OBJECTIVE
Functional assessment of small arteries and arterioles could provide valuable information regarding the extent of diffuse arteriolosclerosis in patients with small-vessel disease. Therefore we attempted to clarify the role of cerebrovascular reactivity (CVR) as a risk marker for first-ever symptomatic lacunar infarction.


METHODS
Forty-six patients with lacunar infarction and 46 sex- and age-matched control subjects were prospectively evaluated. Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. CVR was examined by calculating the percent increase in mean flow velocity occurring after 15 mg/kg acetazolamide administration (Diamox test).


RESULTS
CVR was significantly (P<0.0001, Student's t test) lower in cases (50.0+/-12. 7%) as compared with control subjects (65.2+/-12.4%). A multiple logistic regression analysis identified male sex (odds ratio [OR] 2. 3, P=0.02), age (OR 3.6, P<0.005), and the presence of lacunar infarction on magnetic resonance imaging (OR 5.3, P<0.001) as significant and independent factors associated with a reduction of CVR. Moreover, a cut-point of 55.6% (sensitivity 67%, specificity 82%) was established as the threshold value for distinguishing between pathological and normal CVR. CVR was significantly (P=0.02) lower in patients with multiple (46.38+/-12.6%) than with single (54. 83+/-11.58%) lacunar infarction. In addition, a trend of negative correlation was found between CVR and the number of lacunar infarctions (r=-0.26, P=0.08). In the multiple logistic model, history of hypertension (OR 7.24; 95% confidence interval 2.95 to 17. 79) and CVR (OR 0.8; 95% confidence interval 0.81 to 0.93) emerge as significant and independent predictors of first-ever lacunar infarction.


CONCLUSIONS
These data suggest that impaired CVR is a risk marker for first-ever lacunar infarction.
Molina
C
C
Cerebrovascular Unit, Hospital Vall d'Hebrón, Barcelona, Spain. cmolc@meridian.es
Sabín
J A
JA
Montaner
J
J
Rovira
A
A
Abilleira
S
S
Codina
A
A
D000086:Acetazolamide; D001160:Arterioles / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D002257:Carbonic Anhydrase Inhibitors; D016022:Case-Control Studies; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D005544:Forecasting; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000503:physiopathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D017585:Ultrasonography, Doppler, Transcranial
D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide