IJCNMH ARCpublishing

Issue: Issue 1 (2014) – Supplement 1

Original Article

Clinical predictors of increased middle cerebral artery pulsatility

Ana Gouveia, João Sargento-Freitas, João Madaleno, Joana Penetra, Fernando Alves-Silva, Cristina Machado, Gustavo Cordeiro, and Luís Cunha
Background: Transcranial Doppler Pulsatility Index (PI) has traditionally been interpreted as a descriptor of distal cerebrovascular resistance. Many authors have investigated its usefulness in the context of traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) and hydrocephalus. Nonetheless, many doubts remain about its interpretation in cerebrovascular prevention. The aim of our study is to identify the clinical predictors of increased PI.

Methods: We conducted an analysis of a prospective database including all patients undergoing cerebrovascular ultrasonographic evaluation during 2011. We excluded patients with ?70% stenosis or occlusion in any intra or extracranial artery, stenosis in middle cerebral artery (MCA), atrial fibrillation, patients without transtemporal sonographic window and all evaluations performed in context of TBI, SAH, acute ischemic stroke or intracranial hypertension. The mean PI of both MCA, measured in its middle third after a minimum of 10 minutes of rest in the supine position, was registered. Vascular risk factors and clinical conditions were analyzed.

Results: Of the 947 patients analyzed, 446 were included, of which 287 (64.3%) were male. The mean age was 62.7 years (SD = 14.92) and the mean PI was 0.995 (SD = 0.240). In multivariate analysis, age (regression coefficient Beta (B):0.007, 95% CI: 0.005-0.009, p<0.001), hypertension (B:0.056, 95% CI: 0.003-0.108, p=0.037) and diabetes mellitus (B:0.064, 95% CI: 0.006-0.121, p=0.030) were identified as predictors of increased PI.

Conclusion: These results suggest that PI is associated with vascular risk factors classically responsible for small vessel disease. We discuss the pathophysiology of elevation of PI and its possible usefulness in cerebrovascular prevention.

Keywords: Pulsatility Index, Transcranial Doppler, Cerebrovascular resistance, Small vessel disease, Cerebrovascular prevention.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S17

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