The predictive value of shear rate at carotid stenosis for cerebral infarction in patients with hyperhomocysteinemia

doi:10.11817/j.issn.1673-9248.2024.04.004

Abstract

Abstract:

Objective

To investigate the predictive value of shear rate at carotid artery stenosis for the outcome of cerebral infarction in patients with hyperhomocysteinemia (HHcy).

Methods

A total of 237 patients with HHcy and carotid artery stenosis, admitted to the Department of Neurology, the Fourth Affiliated Hospital of Harbin Medical University from December 2020 to December 2022, were retrospectively enrolled. The patients were divided into the cerebral infarction outcome group and the non-cerebral infarction outcome group, based on the presence or absence of cerebral infarction events. Data of clinical indicators and ultrasound parameters for the two groups were collected. Univariate analysis (independent sample t-test, Mann-Whitney U test and Pearson χ² test) was used to compare the differences in the aforementioned parameters between the two groups. Multivariate Logistic regression was used to analyze the independent risk factors of cerebral infarction outcome. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of relevant indicators for cerebral infarction outcomes.

Results

Compared with the non-cerebral infarction outcome group, the serum Hcy level [(29.39±17.49) μmol/L vs (24.51±10.08) μmol/L], the peak systolic velocity (PSV) at the stenosis [(422.92±138.63) cm/s vs (312.87±98.27) cm/s], the unstable plaque ratio (37.3% vs 9.2%), and shear rate [11 254.76 (8800.00, 15 700.00) s^-1vs 5511.11 (4600.00, 6720.00) s^-1] were higher. The inner diameter of stenosis [0.15 (0.12, 0.19) cm vs 0.22 (0.19, 0.28) cm] was smaller, and the difference was statistically significant (t=-2.384, P=0.018; t=-6.513, P<0.001; χ²=22.117, P<0.001; Z=-12.625, P<0.001; Z=-8.233, P<0.001). Multivariate Logistic regression analysis showed that unstable plaque (OR=5.450, 95%CI: 2.438-12.186, P<0.001), PSV at stenosis (OR=1.010, 95%CI: 1.006-1.013, P <0.001) and shear rate (OR=1.003, 95%CI: 1.002-1.005, P<0.001) were the risk factors for the outcome of cerebral infarction. PSV and the shear rate at the stenosis have significant diagnostic efficacy for the outcome of cerebral infarction in patients. When the cut-off values of PSV and shear rate at the stenosis are 328 cm/s and 7800 s^-1, respectively, they have the best predictive value for the outcome of cerebral infarction in patients, and the diagnostic efficacy of shear rate is significantly better than that of PSV at the stenosis (area under ROC curve: 0.992 vs 0.754, Z=7.577, P<0.001).

Conclusion

Unstable plaque, PSV at stenosis, and shear rate are risk factors for cerebral infarction outcome in HHcy patients with carotid artery stenosis. Among them, the shear rate demonstrates the greatest predictive value for the outcome of cerebral infarction. It can be used as a quantitative indicator to predict the occurrence of cerebral infarction these patients.

Key words: Shear rate, Hyperhomocysteinemia, Severe carotid stenosis, Cerebral infarction

Huanliang Liu, Huijuan Cui, Hui Cao, Yuan Fu. The predictive value of shear rate at carotid stenosis for cerebral infarction in patients with hyperhomocysteinemia[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(04): 317-322.

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临床资料	非脑梗死结局组（n=87）	脑梗死结局组（n=150）	统计值	P值
年龄（岁，）	68.94±9.11	68.85±9.15	t=0.078	0.938
性别[例（%）]			χ²=0.449	0.503
男	67（77.0）	121（80.7）
女	20（23.0）	29（19.3）
高血压史[例（%）]	32（36.8）	72（48.0）	χ²=2.814	0.093
心房颤动史[例（%）]	15（17.2）	34（22.7）	χ²=0.988	0.320
吸烟史[例（%）]	16（18.4）	38（25.3）	χ²=1.509	0.219
体质量指数（kg/m²，）	23.82±3.52	23.05±2.91	t=1.802	0.073
血糖（mmol/L，）	6.11±2.57	6.17±2.00	t=-0.213	0.831
总胆固醇（mmol/L，）	4.88±1.26	5.01±1.19	t=-0.814	0.416
甘油三酯（mmol/L，）	1.76±1.07	1.78±1.34	t=-0.088	0.930
高密度脂蛋白（mmol/L，）	1.07±0.24	1.05±0.22	t=0.832	0.406
低密度脂蛋白（mmol/L，）	2.97±0.98	3.14±0.98	t=-1.302	0.194
血清Hcy（μmol/L，）	24.51±10.08	29.39±17.49	t=-2.384	0.018
狭窄血管[例（%）]			χ²=0.055	0.814
颈内动脉	30（34.5）	54（36.0）
颈动脉球部	57（65.5）	96（64.0）
狭窄部位[例（%）]			χ²=0.045	0.832
左侧	43（49.4）	72（48.0）
右侧	44（50.6）	78（52.0）
狭窄处PSV（cm/s，）	312.87±98.27	422.92±138.63	t=-6.513	<0.001
狭窄处内径[cm，M（Q_R）]	0.22（0.19，0.28）	0.15（0.12，0.19）	Z=-8.233	<0.001
不稳定斑块[例（%）]			χ²=22.117	<0.001
有	8（9.2）	56（37.3）
无	79（90.8）	94（62.7）
剪切率[s^-1，M（Q_R）]	5511.11（4600.00，6720.00）	11 254.76（8800.00，15 700.00）	Z=-12.625	<0.001

临床资料	非脑梗死结局组（n=87）	脑梗死结局组（n=150）	统计值	P值
年龄（岁，）	68.94±9.11	68.85±9.15	t=0.078	0.938
性别[例（%）]			χ²=0.449	0.503
男	67（77.0）	121（80.7）
女	20（23.0）	29（19.3）
高血压史[例（%）]	32（36.8）	72（48.0）	χ²=2.814	0.093
心房颤动史[例（%）]	15（17.2）	34（22.7）	χ²=0.988	0.320
吸烟史[例（%）]	16（18.4）	38（25.3）	χ²=1.509	0.219
体质量指数（kg/m²，）	23.82±3.52	23.05±2.91	t=1.802	0.073
血糖（mmol/L，）	6.11±2.57	6.17±2.00	t=-0.213	0.831
总胆固醇（mmol/L，）	4.88±1.26	5.01±1.19	t=-0.814	0.416
甘油三酯（mmol/L，）	1.76±1.07	1.78±1.34	t=-0.088	0.930
高密度脂蛋白（mmol/L，）	1.07±0.24	1.05±0.22	t=0.832	0.406
低密度脂蛋白（mmol/L，）	2.97±0.98	3.14±0.98	t=-1.302	0.194
血清Hcy（μmol/L，）	24.51±10.08	29.39±17.49	t=-2.384	0.018
狭窄血管[例（%）]			χ²=0.055	0.814
颈内动脉	30（34.5）	54（36.0）
颈动脉球部	57（65.5）	96（64.0）
狭窄部位[例（%）]			χ²=0.045	0.832
左侧	43（49.4）	72（48.0）
右侧	44（50.6）	78（52.0）
狭窄处PSV（cm/s，）	312.87±98.27	422.92±138.63	t=-6.513	<0.001
狭窄处内径[cm，M（Q_R）]	0.22（0.19，0.28）	0.15（0.12，0.19）	Z=-8.233	<0.001
不稳定斑块[例（%）]			χ²=22.117	<0.001
有	8（9.2）	56（37.3）
无	79（90.8）	94（62.7）
剪切率[s^-1，M（Q_R）]	5511.11（4600.00，6720.00）	11 254.76（8800.00，15 700.00）	Z=-12.625	<0.001

因素	B值	SE值	Wald值	P值	OR值	95%CI
同型半胱氨酸（μmol/L）	0.018	0.011	2.874	0.090	1.019	0.997~1.041
不稳定斑块	1.696	0.411	17.059	<0.001	5.450	2.438~12.186
狭窄处内径（cm）	-2.329	1.248	3.486	0.062	0.097	0.008~1.123
狭窄处PSV（cm/s）	0.010	0.002	27.353	<0.001	1.010	1.006~1.013
剪切率（s^-1）	0.003	0.001	19.836	<0.001	1.003	1.002~1.005

因素	B值	SE值	Wald值	P值	OR值	95%CI
同型半胱氨酸（μmol/L）	0.018	0.011	2.874	0.090	1.019	0.997~1.041
不稳定斑块	1.696	0.411	17.059	<0.001	5.450	2.438~12.186
狭窄处内径（cm）	-2.329	1.248	3.486	0.062	0.097	0.008~1.123
狭窄处PSV（cm/s）	0.010	0.002	27.353	<0.001	1.010	1.006~1.013
剪切率（s^-1）	0.003	0.001	19.836	<0.001	1.003	1.002~1.005

指标	AUC	95%CI	P值	截断值	敏感度（%）	特异度（%）
狭窄处PSV（cm/s）	0.754	0.694~0.808	<0.001	328	71.33	63.22
剪切率（s^-1）	0.992	0.971~0.999	<0.001	7800	94.00	97.70
不稳定斑块	0.641	0.571~0.711	<0.001	NA	62.67	90.80

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