RT Journal Article
SR Electronic
T1 Association of Carotid Plaque and Flow Velocity With White Matter Integrity in a Middle-aged to Elderly Population
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e2699
OP e2707
DO 10.1212/WNL.0000000000201297
VO 99
IS 24
A1 David Leander Rimmele
A1 Elina Larissa Petersen
A1 Eckhard Schlemm
A1 Simon S. Kessner
A1 Marvin Petersen
A1 Carola Mayer
A1 Bastian Cheng
A1 Tanja Zeller
A1 Christoph Waldeyer
A1 Christian-Alexander Behrendt
A1 Christian Gerloff
A1 Götz Thomalla
YR 2022
UL http://n.neurology.org/content/99/24/e2699.abstract
AB Background and Objectives It is uncertain whether there is an association of carotid plaques (CPs) and flow velocities with peak width mean diffusivity (PSMD) and white matter hyperintensities (WMH) independent of shared risk factors. We aimed to study this association controlling for biomarkers of inflammation and cardiac dysfunction and typical cardiovascular risk factors and spatial distribution.Methods We included participants from the population-based Hamburg City Health Study, recruiting citizens between 45 and 74 years of age. Medical history was obtained from structured interviews and extended laboratory tests, physical examinations, MRI of the head, echocardiography, and abdominal and carotid ultrasound were performed. We performed multivariable regression analysis with PSMD and periventricular, deep, and total volume of WMH (pWMH, dWMH, tWMH) as dependent variables. PSMD was calculated as the difference between the 95th and 5th percentiles of MD values on the white skeleton in standard space. Volumes of WMH were determined by the application of a manually trained k-nearest neighbor segmentation algorithm. WMH measured within a distance of 1 cm from the surface of the lateral ventricles were defined as pWMH and above 1 cm as dWMH.Results Two thousand six hundred twenty-three participants were included. The median age was 65 years, and 56% were women. Their median tWMH was 946 mm3(IQR:419, 2,164), PSMD 2.24 mm2/s × 10−4 (IQR: 2.04, 2.47), peak systolic velocity (PSV) of internal carotid arteries 0.70m/second (IQR:0.60, 0.81), and 35% had CPs. Adjusted for age, sex, high-sensitive CRP, NT-proBNP, and commonly measured cardiovascular risk and systemic hemodynamic factors, both CPs (B = 0.15; CI: 0.04, 0.26; p = 0.006) and low PSV (B = −0.49; CI: −0.87, −0.11; p = 0.012) were significantly associated with a higher tWMH and PSMD. Low PSV (B = −0.48; CI: −0.87, −0.1; p = 0.013) was associated with pWMH and the presence of CP with pWMH (B = 0.15; CI: 0.04, 0.26; p = 0.008) and dWMH (B = 0.42; CI: 0.11, 0.74; p < 0.009).Discussion Low PSV and CP are associated with WMH and PSMD independent of cardiovascular risk factors and biomarkers of inflammation and cardiac dysfunction. This points toward pathophysiologic pathways underlying both large and small vessel disease beyond the common cardiovascular risk profile.Trial Registration Information The trial was submitted at clinicaltrials.gov, under NCT03934957 on January 4, 2019. The first participant was enrolled in February 2016.CPs=carotid plaques; PSMD=peak-width mean diffusivity; PSV=peak systolic velocity; WMH=white matter hyperintensities