Title: Surrogate Sonographic Markers of Atherosclerosis
Abstract: HomeStrokeVol. 37, No. 7Surrogate Sonographic Markers of Atherosclerosis Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBSurrogate Sonographic Markers of Atherosclerosis Mohammed Abdalla Abbas, MD Francesco Corea, MD Mohammed Abdalla AbbasMohammed Abdalla Abbas South Valley University, Sohag, Egypt, Istituto di Neurologia Sperimentale (INSPE), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele, Milano, Italy Francesco CoreaFrancesco Corea Istituto di Neurologia Sperimentale (INSPE), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele, Milano, Italy Originally published1 Jun 2006https://doi.org/10.1161/01.STR.0000227371.36343.a2Stroke. 2006;37:1644Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 1, 2006: Previous Version 1 To the Editor:We read with interest the work of Staub and coworkers for the comparison of internal carotid artery resistive index (RI) with the common carotid artery intima-media thickness in the prediction of cardiovascular morbidity and mortality. The authors suggest the use of Purcelot criteria for the measurement of RI as a predictor of cardiovascular events.1We should take into account the possible influence of heart rate on RI measurements. Even when arterial blood pressure (ABP) and cardiac output remain constant Mostbeck et al demonstrated a significant decrease in RI with increasing heart rate (HR; HR of 70: RI=0.7±0.06; HR of 120: RI=0.57±0.06; P<0.001).2In the study of Staub and coworkers we noticed that 7% of the patients included in the study were with pulse measurements of <50 or >90 bpm and 11% of the patients were with atrial fibrillation (AF). We consider that the prevalence of AF together with the majority of male sex and wide range of age are not representative of a typical normal dwelling older adult population.3,4 Moreover, in the article no data concerning RI measurements in the AF subgroup is available together with the median age of the general study populations.Many errors may arise from using the RI even in normal patients with irregular heart rhythm because the index may vary from 0.62 to 0.42 (>30%).5 Changes in the waveform are clearly attributable to the fluctuating cardiac output in tachycardia, HR and/or ABP. Additionally, it is reported in the first study6 that the trial use of the Mostbeck correction formula for the RI values did not show any change in mean value or correlation, so the formula was not further applied.There is also a similar score called the Gosling Pulsatility Index, PI (versus-Vd)/Vm, but also in this case the changes in cerebrovascular resistance are easily overshadowed by central cardiovascular factors.5Because a correction of RI values with ABP and HR seems hardly feasible, we suggest the simpler use of a structural and functional surrogate marker obtained by the sum of RI and common carotid artery intima-media thickness. This will minimize the fluctuations attributable to transient systemic cardiovascular abnormalities offering a reliable tool in daily clinical practice.1 Staub D, Meyerhans A, Bundi B, Schmid HP, Frauchiger B. Prediction of cardiovascular morbidity and mortality: comparison of the internal carotid artery resistive index with the common carotid artery intima-media thickness. Stroke. 2006; 37: 800–805.LinkGoogle Scholar2 Mostbeck GH, Gossinger HD, Mallek R, Siostrzonek P, Schneider B, Tscholakoff D. Effect of heart rate on Doppler measurements of resistive index in renal arteries. Radiology. 1990; 175: 511–513.CrossrefMedlineGoogle Scholar3 Paciaroni M, Caso V, Cardaioli G, Corea F, Milia P, Venti M, Hamam M, Pelliccioli GP, Parnetti L, Gallai V. Is ultrasound examination sufficient in the evaluation of patients with internal carotid artery severe stenosis or occlusion? Cerebrovasc Dis. 2003; 15: 173–176.CrossrefMedlineGoogle Scholar4 Bornstein N, Corea F, Galllai V, Parnetti L. Heart-brain relationship: atrial fibrillation and stroke. Clin Exp Hypertens. 2002Oct-Nov; 24: 493–499.CrossrefMedlineGoogle Scholar5 Aaslid R. Cerebral Hemodinamics, in Transcranial Doppler. Newell DW, Aaslid R, eds. New York, NY: Raven Press, Ltd; 1992: 49–55.Google Scholar6 Frauchiger B, Schmid H, Roedel C, Moosmann P, Staub D. Comparison of carotid arterial resistive indices with intima-media thickness as sonographic markers of atherosclerosis. Stroke. 2001; 32: 836–841.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Abbas M, Fawi G, Martinelli V and Corea F (2007) Atherosclerotic Sonographic Markers and Central Cardiovascular Status, Annals of Vascular Surgery, 10.1016/j.avsg.2006.12.003, 21:2, (249-251), Online publication date: 1-Mar-2007. Abbas M, Galantucci S, Parnetti L and Corea F (2007) Atherosclerosis Assessment Confounders in the Rancho Bernardo Study, The American Journal of Cardiology, 10.1016/j.amjcard.2006.10.019, 99:6, (876), Online publication date: 1-Mar-2007. July 2006Vol 37, Issue 7 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000227371.36343.a2PMID: 16741167 Originally publishedJune 1, 2006 PDF download Advertisement