Patologìâ (Aug 2013)
Change of the elasticity COEFFICIENT of the walls of the common carotid artery as a predictor of adverse cardiovascular events in hypertensive patients after ischemic hemispheric stroke. Results of one year observation.
Abstract
Objective. To evaluate the relationship between carotid artery elastic properties and risk of recurrent coronary and cerebral ischemic events in III grade arterial hypertension patients after ischemic stroke. Methods. 102 mild-to-moderate arterial hypertension patients were enrolled to the scrutiny in 3 weeks after ischemic stroke and then they had been being studied prospectively for 12 months period regarding survival rate and unfavorable clinical outcomes. Clinical interviews were performed every 3 months during 1 year after blood sampling. Clinical events included the following: certainly diagnosed ischemic stroke or TIA; coronary ischemic events, sudden death, diabetes mellitus, and all cardiovascular events including chronic heart failure and hospitalization. Elastic properties of carotid artery were determined by high resolution B-modal echography. Results. Univariate analysis has found that age-, gender-, index NIHSS-, Barthel index- and Rankin score index-adjusted variable of total cardiovascular events positively correlated with the presence of type 2 diabetes (R=0.62; P =0.001), systolic BP (R=0.50; P=0.022), the total cholesterol levels (R=0.56; P =0.004), and LDL cholesterol in plasma (R=0,64; P =0,012), fasting blood glucose (R=0,56; P =0,014), and negatively correlated with distensibility coefficient (R=-0.80; P=0.009), cross-section compliance of the common carotid artery (R=-0.70; P=0.004), of pressure-straine elastic modulus (R=-0.64; P =0.041), and the Young's modulus (R=-0.52; P=0.011). Multivariate analysis showed that after exclusion of all indicators with a high level of mutual associations among the variables that have demonstrated the existence of an independent significant association in linear regression with a total value of cardiovascular events elasticity (R = -0,76; P = 0,006), the level of total MS (R = 0,55; P = 0,009), and LDL cholesterol in plasma (R = 0,62; P = 0,014), diabetes mellitus type 2 (R = 0,62; P = 0,004) remained. The most optimal predictive value is the cutoff point of distensibility coefficient is equal to 27.05 kPa (AUC=0.847±0.038; 95% CI =0,774-0,921; sensitivity =90.6%, specificity=70.6%). In conclusion, we suggested that decreased distensibility coefficient less than 27.05 kPa strongly predicts the risk for cumulative clinical cardiovascular events in arterial hypertensive patients after ischemic stroke.
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