Relationships of transcranial blood flow Doppler parameters with major vascular risk factors: TCD study in patients with a recent TIA or nondisabling ischemic stroke.
OBJECTIVE
The relationship between intracranial vascular disease and cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, and total serum cholesterol in patients with recent cerebral ischemia is not well established. We used transcranial Doppler (TCD) sonography tests as parameters of intracranial vascular disease and investigated the relationship between these parameters and conventional cardiovascular risk factors.


METHODS
We prospectively studied 598 patients with a minor ischemic stroke or transient ischemic attack (TIA). In all patients, flow velocities in the left and right middle cerebral artery (MCA), and cerebrovascular reactivity to CO2 were measured by means of TCD sonography. Student's t-test and linear regression analysis were used to determine the relationship between the baseline characteristics, vascular risk factors, and TCD parameters.


RESULTS
After adjustment for other vascular risk factors, a statistically significant relationship with mean flow velocity in the MCA was found for age (3.5 cm/s/10 years of age; 95% CI, 2.5-4.5 cm/s/10 years of age; p < 0.0001), sex (-2.9 cm/s for male sex; 95% CI, -5.5 to -0.3 cm/s; p = 0.03), diabetes (5.6 cm/s for diabetics; 95% CI, 2.1-9.1 cm/s; p = 0.002), and total serum cholesterol (2.4 cm/s per mmol increase in total serum cholesterol; 95% CI, 1.4-3.5 cm/s; p < 0.0001). Total serum cholesterol and hypertension were related to cerebrovascular reactivity to CO2.


CONCLUSIONS
Cerebral flow velocity is influenced by multiple interacting factors. Results of TCD investigations should be adjusted for age, sex, diabetes, and cholesterol when used for diagnostic or prognostic purposes.
Wijnhoud
Annemarie D
AD
Department of Neurology, Erasmus MC, University Medical Center Rotterdam, dr Molewaterplein 40, Room H673, P. O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Koudstaal
Peter J
PJ
Dippel
Diederik W J
DW
D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial