Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of pulsatility index of carotid Doppler ultrasonography to predict cardiovascular events

  • Original Article–Vessels
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

The pulsatility index (PI) obtained from carotid ultrasonography is considered to be a marker of cerebrovascular resistance. However, the impact of PI on cardiovascular events has yet to be fully addressed.

Method

Fifty-four patients who underwent both carotid ultrasonography and coronary angiography were followed for 5.9 ± 3.2 years. The relationship between the incidence of cardiovascular events and PI was investigated.

Result

There were 10 (19%) deaths, four (7%) cardiovascular deaths, and nine (17%) major adverse cardiovascular events (MACEs). The cardiovascular events—defined as all hospitalization for MACEs plus heart failure, revascularization, and cardiovascular surgery—occurred in 21 patients (39%). The patients were divided into two groups according to each threshold of PI value for common carotid arteries (CCA), internal carotid arteries (ICA), and external carotid arteries (ECA), respectively. The thresholds were calculated based on receiver-operating characteristic curves for cardiovascular events. Log-rank test showed that the groups with CCA-PI ≥ 1.71, ICA-PI ≥ 1.20, and ECA-PI ≥ 2.46 had a higher incidence of cardiovascular events, respectively (p < 0.05). ECA-PI ≥ 2.46 was associated with an increased incidence of MACEs. Multivariate Cox regression analysis adjusting for cardiovascular risk factors showed that high PI of CCA, ICA, or ECA was a risk factor for cardiovascular events, respectively (CCA-PI ≥ 1.71, hazard ratio (HR) 3.242, p = 0.042; ICA-PI ≥ 1.20, HR 3.639, p = 0.012; ECA-PI ≥ 2.46, HR 11.322, p = 0.001).

Conclusion

The results suggested that carotid PIs were independent predictive factors for further cardiovascular events. In particular, high ECA-PI levels may reflect severe arteriosclerosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

This manuscript reports the results of clinical trials. The data will not be shared.

References

  1. Parish S, Arnold M, Clarke R, et al. Assessment of the role of carotid atherosclerosis in the association between major cardiovascular risk factors and ischemic stroke subtypes. JAMA Netw Open. 2019;2:e194873.

    Article  Google Scholar 

  2. Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34:290–6.

    Article  Google Scholar 

  3. Wu Y, He J, Sun X, et al. Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus. Medicine. 2017;96:e8151.

    Article  Google Scholar 

  4. Mortimer R, Nachiappan S, Howlett DC. Carotid artery stenosis screening: where are we now? Br J Radiol. 2018;91:20170380.

    Article  Google Scholar 

  5. Chuang SY, Cheng HM, Bai CH, et al. Blood pressure, carotid flow pulsatility, and the risk of stroke; a community-based study. Stroke. 2016;47:2262–8.

    Article  Google Scholar 

  6. Kitaoka M, Terminology and Diagnostic Criteria Committee, Japan Society of Ultrasonics in Medicine. Standard method for ultrasound evaluation of carotid artery lesions. J Med Ultrason. 2009;36:219–26.

    Article  Google Scholar 

  7. Lee KY, Sohn YH, Baik JS. Arterial pulsatility as an index of cerebral microangiopathy in diabetes. Stroke. 2000;31:1111–5.

    Article  CAS  Google Scholar 

  8. Tanaka T, Shimizu T, Fukuhara T. The relationship between leukoaraiosis volume and parameters of carotid artery duplex ultrasonographic scanning in asymptomatic diabetic patients. Comput Med Imaging Graph. 2009;33:489–93.

    Article  Google Scholar 

  9. Webb AJ, Simoni M, Mazzucco S, et al. Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility. Stroke. 2012;43:2631–6.

    Article  Google Scholar 

  10. Mitchell GF, van Buchem MA, Sigurdsson S, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the age, gene/environment susceptibility – Reykjavik Study. Brain. 2011;134:3398–407.

    Article  Google Scholar 

  11. Hashimoto J. Central hemodynamics and target organ damage in hypertension. Tohoku J Exp Med. 2014;233:1–8.

    Article  Google Scholar 

  12. Mitchell GF. Aortic stiffness, pressure and flow pulsatility, and target organ damage. J Appl Physiol. 2018;125:1871–80.

    Article  CAS  Google Scholar 

  13. Aghilinejad A, Amlani F, King KS, et al. Dynamic effects of aortic arch stiffening on pulsatile energy transmission to cerebral vasculature as a determinant of brain-heart coupling. Sci Rep. 2020;10:8784.

    Article  CAS  Google Scholar 

  14. Hampton C, Rosa R, Szeto D, et al. Effects of carvedilol on structural and functional outcomes and plasma biomarkers in the mouse transverse aortic constriction heart failure model. SAGE Open Med. 2017;5:2050312117700057.

    Article  Google Scholar 

  15. deAlmeida AC, van Oort RJ, Wehrens XH. Transverse aortic constriction in mice. J Vis Exp. 2010;38:1729.

    Google Scholar 

  16. Hitsumoto T. Relationships between the cardio-ankle vascular index and pulsatility index of the common carotid artery in patients with cardiovascular risk factors. J Clin Med Res. 2019;11:593–9.

    Article  CAS  Google Scholar 

  17. Oughton JA, Rose S, Galloway G, et al. Carotid ultrasound pulsatility indices and cardiovascular risk in Australian women. J Med Imaging Radiat Oncol. 2015;59:20–5.

    Article  Google Scholar 

  18. Masaki N, Sato A, Horii S, et al. Usefulness of the d-ROMs test for prediction of cardiovascular events. Int J Cardiol. 2016;222:226–32.

    Article  Google Scholar 

  19. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381:629–38.

    Article  Google Scholar 

  20. Imai E, Horio M, Nitta K, et al. Estimation of glomerular filtration rate by the MDRD study equitation modified for Japanese patients with chronic kidney disease. Clin Exp Nephrol. 2007;11:41–50.

    Article  Google Scholar 

  21. Scheel P, Ruge C, Schöning M. Flow velocity and flow volume measurements in the extracranial carotid and vertebral arteries in healthy adults: reference data and the effect of age. Ultrasound Med Biol. 2000;26:1261–6.

    Article  CAS  Google Scholar 

  22. Albayrak R, Degirmenci B, Acar M, et al. Doppler sonography evaluation of flow velocity and volume of the extracranial internal carotid and vertebral arteries in healthy adults. J Clin Ultrasound. 2007;35:27–33.

    Article  Google Scholar 

  23. Tanaka A, Tomiyama H, Maruhashi T, et al. Physiological diagnostic criteria for vascular failure. Hypertension. 2018;72:1060–71.

    Article  CAS  Google Scholar 

  24. Tanaka A, Tomiyama H, Maruhashi T, et al. Official announcement of physiological diagnostic criteria for vascular failure from the Japanese society for vascular failure. Vasc Fail. 2018;2:59–60.

    Article  Google Scholar 

  25. Nakatou T, Nakata K, Nakamura A, et al. Carotid haemodynamic parameters as risk factors for cerebral infarction in Type 2 diabetic patients. Diabet Med. 2004;21:223–9.

    Article  CAS  Google Scholar 

  26. Chang YJ, Lin CM, Ou YH, et al. Carotid duplex parameters to predict long term outcomes of ischemic stroke patients receiving intra-arterial thrombectomy treatment. Medicine. 2019;98:e15734.

    Article  Google Scholar 

  27. Petrica L, Petrica M, Munteanu M, et al. Cerebral microangiopathy in patients with non-insulin-dependent diabetes mellitus. Ann Acad Med Singap. 2007;36:259–66.

    PubMed  Google Scholar 

  28. Jahromi AS, Cinà CS, Liu Y, et al. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg. 2005;41:962–72.

    Article  Google Scholar 

  29. Rafati M, Havaee E, Moladoust H, et al. Appraisal of different ultrasonography indices in patients with carotid artery atherosclerosis. EXCLI J. 2017;16:727–41.

    PubMed  PubMed Central  Google Scholar 

  30. Ackerstaff RG, Moons KG, van de Vlasakker CJ, et al. Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy. Stroke. 2000;31:1817–23.

    Article  CAS  Google Scholar 

  31. Kaszczewski P, Elwertowski M, Leszczynski J, et al. Volumetric carotid flow characteristics in Doppler ultrasonography in healthy population over 65 years old. J Clin Med. 2020;9:1375.

    Article  Google Scholar 

  32. Lau KK, Pego P, Mazzucco S, et al. Age and sex-specific associations of carotid pulsatility with small vessel disease burden in transient ischemic attack and ischemic stroke. Int J Stroke. 2018;13:832–9.

    Article  Google Scholar 

  33. Chuang SY, Bai CH, Cheng HM, et al. Common carotid artery end-diastolic velocity is independently associated with future cardiovascular events. Eur J Prev Cardiol. 2016;23:116–24.

    Article  Google Scholar 

  34. Namba T, Masaki N, Takase B, et al. Arterial stiffness assessed by cardio-ankle vascular index. Int J Mol Sci. 2019;20:3664.

    Article  CAS  Google Scholar 

Download references

Funding

This research was supported by a grant (to Adachi T) from the Ministry of Defense of Japan and a grant-in-aid for scientific research from the Ministry of Education, Science, and Culture of Japan (to Masaki N) (20K08503).

Author information

Authors and Affiliations

  1. Department of Cardiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan

    Yasuhiro Hitomi, Kazuki Kagami, Risako Yasuda, Takumi Toya, Takayuki Namba, Yuji Nagatomo & Takeshi Adachi

  2. Department of Intensive Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan

    Nobuyuki Masaki, Takumi Toya & Bonpei Takase

  3. Department of Endocrinology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan

    Yuki Ishinoda

Authors
  1. Yasuhiro Hitomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nobuyuki Masaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuki Ishinoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuki Kagami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Risako Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takumi Toya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takayuki Namba
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuji Nagatomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bonpei Takase
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takeshi Adachi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nobuyuki Masaki.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This clinical study conformed to the ethical guidelines of the Declaration of Helsinki and was approved by the ethics committee of our institute (No. 1084).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 111 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hitomi, Y., Masaki, N., Ishinoda, Y. et al. Effectiveness of pulsatility index of carotid Doppler ultrasonography to predict cardiovascular events. J Med Ultrasonics 49, 95–103 (2022). https://doi.org/10.1007/s10396-021-01164-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-021-01164-5

Keywords

Search

Navigation