| 1.Background and objectives:Acute ischemic stroke is still the main cause of death and long-term disability worldwide.On the other hand,the cognitive function of patients with ischemic stroke is impaired to varying degrees.About 64% of patients with stroke have cognitive impairment,which causes severe trauma to the patient and to the family,both financially and physically.Arterial stiffness,especially those assessed by pulse wave velocity(PWV),is worth studying.Pulse pressure reflects arterial stiffness and is one of the earliest detectable signs of changes in vascular wall function and structure.Several studies have shown that increased PWV,including carotid-femoral pulse wave velocity(cfPWV)and brachial-ankle pulse wave velocity(baPWV),is associated with poor function after acute ischemic stroke(AIS).Some studies had different conclusions.Studies have shown that the higher PWV is a risk factor for cognitive impairment,and that higher PWV is associated with white matter lesions.A new method for measuring carotid-cerebral stiffness,carotid-cerebral pulse wave velocity(ccPWV),has been discovered recently.Therefore,it is necessary to evaluate the applicability of ccPWV as a prognostic indicator of functional and cognitive outcomes after AIS.The aim of this study was to assess the relationship between ccPWV confirmed cerebral artery stiffness and functional prognosis and cognitive outcomes after AIS.1.Materials and methods:This study is a hospital-based retrospective study.117 patients with first acute ischemic stroke(within 7 days of onset of AIS)registered in our ais database during the period from October 1,2017 to December 30,2018 were recorded.2.Data acquisition:we collected data on sex,age,initial score of National Institute of Health Stroke Scale(NIHSS),use of anticoagulants at admission,antiplatelet aggregation drugs,presence of risk factors [including hypertension,diabetes,coronary atherosclerotic heart disease,hyperlipidemia,current smoking,blood pressure(BP),and body mass index(BMI)],laboratory data,stroke subtypes,use of drugs at admission,and functional outcomes for each patient.Long-term functional outcomes were assessed by a modified Rankin scale(mRS)through telephone.The poor functional prognosis was defined as m RS score>2 in this study.Cognitive impairment was defined as TICS-M score <33.(1)Statistical analyses:All baseline variables were analyzed.Data were expressed as mean ± standard deviation(SD)or median(25th and 75th percentiles)for continuous variables and as frequency and percentage for discrete variables.Comparisons between patients with mild and severe initial severity were performed by unpaired Student’s t-test for continuous variables,and chi-square test for categorical variables.To evaluate the discriminant ability of ccPWV prediction function results,the receiver operating characteristic(ROC)curve analysis was used.The area under the curve(AUC)was calculated to determine the optimal cutoff value was the level with the highest Youden index.And to determine the predictors of dysfunction,we’re doing logistic regression,and calculated odds ratios(OR)and 95% confidence intervals(CI).Statistical significance was established at p < 0.05.Statistical analyses were performed using the SPSS 19.0 software for Windows.2.Results:A total of 91 data were obtained in this study,91 in the functional prognosis group and 52 in the cognitive outcome group.Of these,78 were men,accounting for 85.71 percent.The mean age of all patients was 59.78±8.63 years,and the mean pulse velocity of the artery was 773.24±214.41 cm/s.(1)the diagnostic value of ccPWV for initial severity:Total 91 patients with acute functional status were collected,of which 65 were wellfunctioning.Their mean value of ccPWV is 741.39±207.15 cm/s,26 patients had poor outcome and the mean of ccPWV is 852.89 ± 215.43.the difference between the two groups was statistically significant(p=0.024<0.05).Using the ROC to calculate the association between ccPWV and severe initial symptoms: It is concluded that the area under the curve(AUC)is 0.647,p=0.029<0.05,the Youden index is 0.269,and the critical value is 756.7 cm/s,which is considered to be of diagnostic value for severe acute symptoms.Logistics regression analysis: ccPWV >756.7cm/s was an independent risk factor for acute poor functional status(OR=3.387,p=0.043<0.05)when performing logistics regression analysis on patient age,systolic blood pressure,diastolic blood pressure,cerebrovascular disease risk factors(smoking,hypertension,diabetes,lipid metabolism disorder),BMI、ccPWV>756.7cm/s.(2)the diagnostic value of ccPWV for long-term prognosis:The functional prognosis group included 91 patients,including 20 poor prognosis,71 good prognosis,the mean ccPWV poor prognosis group was 866.824±206.91 cm/s,the prognosis group was 743.449±219.25 cm/s,p=0.012<0.05,the difference was statistically significant.Meanwhile,chi-square test with different functional prognosis acute stage NIHSS score greater than or equal to 4 points found that p=0.000<0.05,the difference was statistically significant.The study also found that the chi-square test p=0.038<0.05 for the proportion of smokers in different functional prognosis patients,and the difference was statistically significant.The diagnostic value of ccPWV for longterm poor prognosis: using the ROC curve to calculate the association between ccPWV and poor prognosis,it is concluded that the area(AUC)under the curve is 0.705,the p<0.05,Youden index is 0.379,and the critical value is 722.85 cm/s,which is considered to be of diagnostic value for poor prognosis.logistics regression analysis: ccPWV>722.85cm/s had no statistical significance for the poor prognosis.(3)ccPWV diagnostic value of cognitive outcomes:a.the inter-group differences among the parameters of different cognitive outcomes: the cognitive outcome group included 51 patients,including 27 in the cognitive impairment group,24 in the normal cognitive function group,and the average ccPWV in the cognitive impairment group was 828.48±185.93 cm/s,the cognitive function group 711.79±211.12 cm/s,p=0.041<0.05.the difference was statistically significant,that is,the patients with different cognitive outcomes were different.Meanwhile,the Fazekas scores of different cognitive outcomes were t tested,and the results showed that the Fazekas scores of cognitive impairment group were 2.72±1.74,the Fazekas scores of normal cognitive function group were 1.55±1.64,and the difference was statistically significant,that is,the scores of patients with different cognitive outcomes were different.Age,time after stroke,BMI and medication were not statistically significant.b.diagnostic value of ccPWV on cognitive impairment: Using the ROC curve to calculate the association between ccPWV and cognitive decline,it is concluded that the area(AUC)under the curve is 0.696,the p=0.017<0.05,Youden index is 0.384,and the critical value is 820.9 cm/s,which is considered that the increase of ccPWV has diagnostic value for cognitive dysfunction.c.effects of multiple factors on cognitive outcomes(logistics regression analysis): logistics regression analysis of patients’ age,time after stroke,risk factors of cerebrovascular disease(smoking,hypertension,diabetes,lipid metabolism disorder),medication status(antihypertensive,hypoglycemic,antiplatelet,lipid-regulating drugs),initial NIHSS score,BMI,degree of leukoencephalopathy,ccPWV>820.9 cm/s 、 systolic and diastolic blood pressure)showed that the degree of leukoencephalopathy(Fazekas score)and ccPWV>820.9 cm/s had a significant effect on cognitive outcome,while other indexes such as systolic and pulse pressure had no significant effect on cognitive function.d.ccPWV and white matter lesions correlation analysis: There was a negative correlation between white matter lesions(Fazekas score)and cognitive score(TICSM).The correlation between peripheral and deep white matter lesions and cognitive score was analyzed.4.Conclusions:(1)Higher ccPWV at acute ischemic stroke is an independent risk factor for initial severity.(2)Increased ccPWV in patients with acute ischemic stroke has predictive value for long-term poor prognosis,but is not an independent risk factor.(3)Increased ccPWV in patients with acute ischemic stroke has predictive value for cognitive deterioration and is an independent risk factor for cognitive impairment.(4)White matter lesions are independent risk factors for cognitive decline,especially in memory,language and attention. |
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