E. Titianova 1,4, I. Velcheva 5, S. Karakaneva 1, K. Hristova 5, Z. Ramsheva 2, K. Ramshev 3
1 Clinic of Functional Diagnostics of Nervous System,
2 Clinical Laboratory,
3 Department of Cardiology and Intensive Care, Military Medical Academy – Sofia,
4 Medical Faculty of Sofia University St. K. Ohridski – Sofia,
5 State University Hospital of Neurology and Psychiatry, Medical University – Sofia, Bulgaria
Objective: To study the relationship between carotid pathology, cardiac function and risk factors (RF) for cerebrovascular diseases (CVDs).
Material and Methods: Color duplex sonography of carotid arteries was performed in 924 patients: 368 with RF for CVDs, 126 with transient ischemic attacks (TIAs), 287 with chronic unilateral infarction (CUI) and 143 with multiple infarctions. The intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured by B-mode and M-mode scanning. Nonmodifiable (age and sex) and some modifiable (hypertension, diabetes mellitus, atrial fibrillation or other cardiac conditions, dyslipidemia, carotid artery stenoses and obesity) RF for CVDs were evaluated. In 67 subjects with RF, 57 patients with CVDs (31 with TIAs and 26 with CUI) and 16 healthy volunteers correlative clinical, neurosonographic and echocardiographic investigations were performed.
Results: Arterial hypertension was the most common RF in all patients. An asymmetrical hypertrophy of the left ventricle of the heart and a decrease of its contractility were found as a typical cardiac dysfunction in most of them. Mild ICA stenoses predominated in all groups while moderate and severe carotid stenoses were relatively rare. Symptomatic ICA thromboses were seen in 4.5% from the patients with CUI. IMT of the ICA on the side of infarction correlated positively with the arterial blood pressure (r=+0.60, p<0.05). A positive correlation was established between CCA diastolic blood flow and cardiac ejection fraction in patients with TIAs and CUI. In the group with CUI the increase in mean arterial blood pressure correlated with the frequency of the non-stable ICA plaques on the infarcted side.
Discussion: The study confirms the multifactorial pathogenesis of CVDs where the clinical impact of carotid pathology alone or its association with other RF is under consideration.
Key words: carotid duplex sonography, cardiac function, cerebrovascular diseases, risk factors.