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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

A NOVEL APPROACH TO COLOR DOPPLER HAEMODYNAMICS: CEREBROVASCULAR EVENTS AND SPECIAL ROLE OF END-DIASTOLIC VELOCITY
M. Dilić, S. Pehar, O. Terzić, S. Kazić, M. Kulić and D. Mott .
Institute of Vascular Diseases, Clinic of Cardiosurgery, Clinical Center University of Sarajevo, General Hospital Orašje, Bosnia and Herzegovina

Background: A possible role of Color Doppler haemodynamic parameters and its relationship with overall outcome of cerebrovascular and peripheral vascular diseases is a top question in nowadays vascular medicine. There are very few studies analysing blood flow velocity parameters of common carotid arteries (CCA), obtained with Color Doppler examination, by multivariante analysis as a predictor in cerebrovascular events (CVE). In everyday clinical practice there are a number of pts. without carotid stenosis or occlusion but with decreased diastolic velocity parameters. Our aim was to compare clinical variables and analytical parameters focusing on diastolic velocity parameters in pts. without stenotic or occlusive disease.
Methods: we included total of 71 pts. who had a CVE, 39 females, 32 males, mean age 65±7, 29 had TIAs, 17 had recurrent TIAs, 18 developed IS, and 7 recurrent IS. All pts. were without carotid stenosis or occlusion. We included the following clinical variables: age, gender, hypertension, tobacco, hyperlipidemia, obesity, diabetes mellitus, and velocity parameters: peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), resistive index (RI), lumen diameter (LD), and intima-media thickness IMT. Color Doppler examination was perfomed on distal portion of CCA, and we took the mean of both CCA.
Results:
we found significance for the following variables: age, hypertension, tobacco, hyperlipidemia, obesity, PSV, EDV, and IMT. Regression logistic test, with 95% confidence interval, was perfomed and we got an independent risk factors for CVE in our group of pts: age (p=0,007), hypertension (p=0,004), smoking (p=0,0010), obesity (p=0,006), peak-systoloc velocity (0=0004), end-distalic velocity (0=0,006). Decreased EDV (below 18 cm/sec) revealed a significant association with CVE, sensitivity of 52% and specificity of 83 %. The EDV below 18 cm/sec criterion was the best single predictor of TIAs (sensitivity 61%, specificity 89%), while 14 cm/sec criterion was predictor of IS and recurrent IS (sensitivity 67%, specificity 79%).
Conclusion: (a) in our pts with CVE - age, hypertension, tobacco, obesity, increased PSV, and decreased EDV were the only independent risk factors for CVE. (b) relative risk for cerebrovascular events in pts. with decreased EDV below 14 cm/sec is 3 times than in pts. with higher levels.

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