FACTORS ASSOCIATED WITH PATHOLOGICAL CARDIO-ANKLE VASCULAR INDEX IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Aim. To compare the clinical significance of the pathological cardio-ankle vascular index (CAVI) and the abnormal ankle-brachial index (ABI) in patients with acute stroke, and to assess the factors associated with the presence of pathological CAVI in these patients.

Methods. 375 patients with stroke (aged 65,0±7,5 years, 200 men and 175 women) were examined in the Department of Neurology at Cardiac Dispensary. All patients were assigned into three groups based on CAVI and ABI: Group 1 - patients with CAVI<9.0 and ABI>0.9 (n= 131), Group 2 - patients with CAVI>9.0 and ABI>0.9 (n = 153), Group 3 - patients with ABI<0.9 (n = 91).Data on rior vascular events and the presence of cardiovascular disease were colledcted. All patients underwent colour Duplex scanning of brachiocephalic arteries, echocardiography, electrocardiography, and laboratory testing (lipid profile, complete blood count, biochemical blood assay, coagulation profile). Arterial stiffness was measured with the VaSera VS-1000.

Results We found that patients with abnormal levels of CAVI (40.8%) were more likely to have concomitant cardiovascular disease (diabetes, chronic heart failure, rhythm disturbances). Patients with abnormal CAVI more often had extracranial artery stenoses (p = 0.001), thickened intima-media complex (p = 0.02), and atrial fibrillation (p = 0.007) compared to patients with normal CAVI.

Conclusion The assessment of cardio-ankle vascular index is preferable in patients with stroke. It allows timely identifying patients with increased arterial stiffness and peripheral artery disease and initiating targeted therapeutic procedures. 

1. Martsevich S. Yu., Kutishenko N.P. The primary care physician role in primery stroke prvention. The place for antihypertensive therapy. Cardiovascular therapy and prevention. 2014; 13(4): 64-68. (In Russ.)

2. Drapkina O.M., Mandzhieva B.A. A vessel age. Mechanisms of vessel wall ageing. Methods of assessment. Cardiovascular therapy and prevention. 2014;13(5): 74-82. (In Russ.)

3. Miyoshi T., Ito H. Assessment of arterial stiffness using the cardio ankle vascular index. Pulse (Basel). 2016; 4(1): 11-23.

4. Natsional’nye rekomendatsii po vedeniyu patsientov s sosudistoi arterial’noi patologiei (Rossiiskii coglasitel’nyi dokument). Chast’1. Perifericheskie arterii. – M.: Izd-vo NTsSSKh im. A. N. Bakuleva RAMN. 2010. – 176 s.(In Russ).

5. Rekomendatsii evropeiskogo obshchestva kardiologov po diagnostike i lecheniyu zabolevanii perifericheskikh arterii (2011). Ratsional’naya farmakoterapiya v kardiologii. 2012; Prilozhenie №4: 4-73. (In Russ).

6. Suzuki J., Sakakibara R., Tomaru T., Tateno F, Kishi M, Ogawa E, et al. Stroke and cardio-ankle vascular stiffness index. J. Stroke Cerebrovasc Dis. 2013; 22(2): 171–175.

7. Saji N., Kimura K., Yagita Y., Kawarai T, Shimizu H, Kita Y., et al. Comparison of arteriosclerotic indicators in patients with ischemic stroke: ankle-brachial index, brachial-ankle pulse wave velocity and cardio-ankle vascular index. Hypertens Res. 2015; 38(5): 323–328.

8. Sumin A.N., Kolmykova Yu.A., Ott M.V., Kukhareva I.N., Sumin D.A., Vodop’yanova N.I., Morkvenas A.A., Trubnikova O.A., Kovalenko A.V. Klinicheskoe znachenie otsenki serdechno-lodyzhechnogo sosudistogo indeksa u bol’nykh s ostrym narusheniem mozgovogo krovoobrashcheniya. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2016; 116(8): 44-49. (In Russ).

9. Schillaci G., Battista F., Settimi L., Anastasio F., Pucci G. et al. Cardio- ankle vascular index and subclinical heart disease. Hypertens Res. 2015; 38(1): 68-73.

10. Gomez-Sanchez L., Garcia-Ortiz L., Patino-Alonso M.C., Recio- Rodriguez J.I., Frontera G., Ramos R. et al. MARK Group. The association between the cardio-ankle vascular index and other parameters of vascular structure and function in caucasian adults: MARK Study. J Atheroscler Thromb. 2015; 22(9): 901-911.

11. Namekata T., Suzuki K., Ishizuka N., Shirai K. Establishing baseline criteria of cardio-ankle vascular index as a new indicator of arteriosclerosis: a cross-sectional study. BMC Cardiovascular Disorders. 2011; 11:51.

12. Vasyuk Yu.A., Ivanova S.V., Shkol’nik E.L., Kotovskaya Yu.V., Milyagin V.A., Oleynikov V.E., Orlova Ya.A., Sumin A.N., Baranov A.A., Boytsov S.A., Galyavich A.S., Kobalava Zh.D., Kozhevnikova O.V., Konradi A.O., LopatinYu.M., MareevV.Yu., Novikova D.S., Oganov R.G., Rogoza A.N., Rotar’O.P., Sergatskaya N.V., Skibitskiy V.V. Soglasovannoe mnenie rossiyskikh ekspertov po otsenke arterial’noy zhestkosti v klinicheskoy praktike. Kardiovaskulyarnaya terapiya i profilaktika. 2016; 15(2): 4–19. (In Russ).

13. Rumjanceva S.A., Oganov R.G., Silina E.V., Stupin V.A., Bolevich S. B., Orlova A.S., i dr. Serdechno-sosudistaja patologija pri ostrom insul’te (nekotorye aspekty rasprostranennosti, profilaktiki i terapii). Kardiovaskuljarnaja terapija i profilaktika. 2014; 13(4): 47-53. (In Russ).

14. Homma S, Kato K, Hayashi J, Yamamoto M. Negative associations between arterial stiffness parameter evaluated by cardio-ankle vascular index and serum low-density lipoprotein cholesterol concentration in early- stage atherosclerosis. Angiology. 2015; 66(2): 143-149.

15. Wang H, Liu J, Zhao H, Fu X, Shang G, Zhou Y, et al. Arterial stiffness evaluation by cardio-ankle vascular index in hypertension and diabetes mellitus subjects. J Am Soc Hypertens. 2013; 7(6): 426-431.

16. Dobsak P, Soska V, Sochor O, Jarkovsky J, Novakova M, Homolka M, et al. Increased cardio-ankle vascular index in hyperlipidemic patients without diabetes or hypertension. J Atheroscler Thromb. 2015; 22(3): 272-83.

17. Sumin A.N., Osokina A.V., Shcheglova A.V., Frolova S.A., Barbarash O.L. Otsenka serdechno-lodyzhechnogo sosudistogo indeksa u bol’nykh IBS s razlichnym tipom diastolicheskoy disfunktsii levogo zheludochka. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2016; 2: 51-58. (In Russ).

18. Namba T, Masaki N, Matsuo Y, Sato A, Kimura T, Horii S, Yasuda R, Yada H, Kawamura A, Takase B, Adachi T. Arterial stiffness is significantly associated with left ventricular diastolic dysfunction in patients with cardiovascular disease. Int Heart J. 2016; 57(6): 729-735.

19. Kadota K., Takamura N., Aoyagi K., Yamasaki H., Usa T., Nakazato M., et al. Availability of cardio-ankle vascular index (CAVI) as a scrining tool for atherosclerosis. Circ J. 2008; 72: 304-308.

20. Izuhara M., Shioji K., Kadota S., Baba O., Takeuchi Y., Uegaito T. et al. Relationship of cardio-ankle vascular index (CAVI) to carotid and coronary arteriosclerosis. Circ J. 2008; 72(11): 1762–1767.

21. Noike H., Nakamura K., Sugiyama Y., Iizuka T., Shimizu K., Takahashi M. et al. Changes in cardio-ankle vascular index in smoking cessation. J Atheroscler Thromb. 2010; 17(5): 517–525.

22. Takatori K., Matsumoto D., Okada Y., Nakamura J., Shomoto K. Effect of intensive rehabilitation on physical function and arterial function in community-dwelling chronic stroke survivors. Top Stroke Rehabil. 2012; 19(5): 377-383.

23. Saji N., Toba K., Sakurai T. Cerebral small vessel disease and arterial stiffness: tsunami effect in the brain? Pulse (Basel). 2016; 3(3-4): 182-189.

24. van Sloten T.T., Protogerou A.D., Henry R.M., Schram M.T., Launer L.J., Stehouwer C.D. Association between arterial stiffness, cerebral small vessel disease and cognitive impairment: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2015; 53:121-130.

25. Sumin A.N., Kolmykova Yu.A., Ott M.V., Kukhareva I.N., Vodop’yanova N.I., Morkvenas A.A., Trubnikova O.A., Kovalenko A.V. Godovoy prognoz u bol’nykh s ostrym narusheniem mozgovogo krovoobrashcheniya: rol’ patologicheskogo lodyzhechno-plechevogo indeksa. Ratsional’naya farmakoterapiya v kardiologii. 2016; 12(6): 638-644.(In Russ)