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Investigation of circle of Willis variants and hemodynamic parameters in twins using transcranial color-coded Doppler sonography

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Abstract

Morphological and hemodynamic variations of the circle of Willis (CW) may have an important impact on cerebrovascular events. However, the environmental and genetic influence remains unclear. For this reason we studied the variations and hemodynamic parameters of the CW in twins using transcranial color-coded sonography (TCCS). Sixty-four twins, 19 monozygotic (MZ) and 13 dizygotic (DZ) pairs from the Italian Twin Registry (average age 45.0 ± 13.7 years) underwent TCCS and risk factor assessment. We examined CW morphology and recorded peak systolic velocity (PSV), end-diastolic velocity (EDV) and pulsatility index (PI). Raw heritability was determined for hemodynamic parameters, whereas concordance and discordance rates were calculated for CW morphological variants. A normal CW anatomy was observed in the majority of MZ and DZ twins (76.5% and 92.3%, respectively). The most frequent variant was a missing anterior cerebral artery (ACA). There was no significant difference in the prevalence of most CW variants depending on the zigosity. Concordance rates were low regarding the presence of variant CW anatomy both in MZ and DZ groups (0.14 and 0.00, respectively). Women had a significantly higher PI in vertebral arteries (VA) and in the right ACA (p = 0.01, p = 0.02 and p < 0.01, respectively). An inverse correlation was observed between hemodynamic parameters and age. Morphological variants of the CW do not seem to be heritable; they are most likely determined by environmental factors. In contrast, hemodynamic parameters of the CW are moderately heritable and this might have implications in the management and prevention of cerebrovascular diseases.

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Acknowledgements

The research was supported by Balassi Institute, Hungarian Scholarship Office and Italian Cultural Institute, Semmelweis University Directorate of International Relations and University of Padua. The auhors thank dr. Philip Auyang for the help with English language editing. For request, the article’s supporting data and materials can be accessed.

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  1. Bianka Forgó, Ádám Domonkos Tárnoki and Dávid László Tárnoki have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Semmelweis University, Üllői Street 78/A, Budapest, 1082, Hungary

    Bianka Forgó, Ádám Domonkos Tárnoki & Dávid László Tárnoki

  2. Hungarian Twin Registry, Erdélyi Street 29, Budapest, 1212, Hungary

    Ádám Domonkos Tárnoki & Dávid László Tárnoki

  3. Central European University, Nádor Street 9, Budapest, 1051, Hungary

    Levente Littvay

  4. Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy

    Corrado Fagnani, Maria Antonietta Stazi & Emanuela Medda

  5. Department of Neurosciences, University of Padua School of Medicine, via Giustiniani 5, 35128, Padua, Italy

    Giorgio Meneghetti, Filippo Farina & Claudio Baracchini

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  1. Bianka Forgó
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Forgó, B., Tárnoki, Á.D., Tárnoki, D.L. et al. Investigation of circle of Willis variants and hemodynamic parameters in twins using transcranial color-coded Doppler sonography. Int J Cardiovasc Imaging 34, 1419–1427 (2018). https://doi.org/10.1007/s10554-018-1359-4

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