Predicting the development of ischemic stroke in patients with cerebral atherosclerosis and diabetes mellitus

Abstract

Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients. The aim of our study is to predict the development of IS based on indicators of the structural and functional state of the heart and cerebral vessels and heart rate variability in patients with cerebral atherosclerosis (CA) and DM2. Materials and methods. The complex clinical and instrumental study involved 229 patients with CA 1–3 degrees. Study design: simple, prospective, non-randomized, sequential enrollment. All patients underwent instrumental examinations: transthoracic echocardiography, electrocardiography ECG, ultrasound Doppler of the vessels of the head and neck, MRI of the brain. All patients took antihypertensive and antidiabetic drugs, antiplatelet agents, statins. Results: Patients were divided into 2 groups: I - with CA 1–2 degrees, II - with CA 3 degrees (after ischemic atherothrombotic stroke (IS)). Average age = 65.1 ± 10.5 and 65.4 ± 9.1 years, respectively. The share of men was 21.2% in the 1st and 52% in the 2nd groups. The number of patients with type 2 diabetes, mean fasting glucose and glycosylated hemoglobin levels were comparable in both groups. At the time of examination, all patients achieved the target BP and T2DM compensation. In our study, for patients with CA, a negative relationship between ischemic stroke and end-diastolic size index and a positive relationship with the thickness of the interventricular septum and male sex was established, which logically explains the important role of LV geometry in the development of ischemic stroke. For patients with T2DM, a negative relationship was found between ischemic stroke and LV diastolic function and positive - with fasting glucose and IM thickness. Conclusion: Based on multivariate regression analysis, in patients with cerebral atherosclerosis with the development of ischemic stroke, the presence of a relationship between the thickness of the interventricular septum, end-systolic size index, end-diastolic size index and the male sex was revealed (AUC = 0.94 (CI 0.91 - 0.97), but in patients with DM2 and CA - fasting glucose level, interventricular septum thickness, intima-media complex thickness and E/A AUC = 0.99 (95% CI 0.94 - 1.00).

Keywords

• cerebral atherosclerosis, diabetes mellitus, predicting ischemic stroke