Relationship between Obesity and Pressure Ratio in Symptomatic Intracranial Atherosclerosis

doi:10.3969/j.issn.1673-5765.2023.12.010

Abstract

Abstract: Objective To investigate the association between obesity and reduced translesional pressure ratio (PR) in patients with symptomatic intracranial atherosclerosis stenosis (sICAS).
Methods Data from this study were obtained from the Chinese National Stroke Registry Ⅲ (CNSR-Ⅲ). sICAS patients with HR-MRI data in the database were included. Three-dimensional meshes were created based on TOF-MRA, and pressure values were obtained by modeling with a finite element method. A PR of≤0.76 between distal and proximal pressure of the stenosis indicated diminished residual blood flow after stenosis. Patients were divided into low or normal weight group, overweight group and obese group according to the BMI. The association between obesity and PR reduction was analyzed by logistic regression, the confounding factors that may affect PR value such as age, sex, history of smoking, history of heavy drinking, history of hypertension, history of diabetes, dyslipidemia, and degree of stenosis were adjusted.
Results A total of 438 patients [median age 64 (57-71) years, 148 cases (33.79%) were female] were included in the analysis. The median PR of the low or normal weight group, the overweight group and the obese group were 0.90 (0.78-0.96), 0.89 (0.73-0.96) and 0.82 (0.52-0.94), respectively, and the difference between the three groups was statistically significant (P=0.044). Multifactorial logistic regression analysis showed that after adjusting for age, sex, history of smoking, history of heavy drinking, history of hypertension, history of diabetes, dyslipidemia and degree of stenosis, obesity was the risk factor for reduced PR in sICAS patients (OR 2.551, 95%CI 1.328-4.902, P=0.005). In addition, in subgroup analysis by age, adjusted for sex, smoking history, heavy drinking history, hypertension history, diabetes history, dyslipidemia, and degrees of stenosis, obesity was the risk factor for reduced PR in patients ≥65 years of age (OR 2.913, 95%CI 1.118-7.590, P=0.029). In subgroup analysis by gender, in female patients, adjusted for age, history of hypertension, history of diabetes, dyslipidemia and degrees of stenosis, obesity was still the risk factor for reduced PR in sICAS patients (OR 3.673, 95%CI 1.174-11.493, P=0.002).
Conclusions Obesity may be a risk factor for reduced PR in sICAS patients. Whether PR can be improved and cerebral perfusion increased by weight loss needs further study.

Key words: Obesity; Arterial stenosis; Translesional pressure ratio; Hemodynamics

摘要： 目的研究肥胖与症状性颅内动脉粥样硬化狭窄（symptomatic intracranial atherosclerosis stenosis，sICAS）患者跨病变压力比（pressure ratio，PR）减低的关系。
方法本研究数据来源于中国国家卒中登记Ⅲ数据库。纳入数据库中具有HR-MRI影像学资料的sICAS患者进行分析。采用TOF-MRA成像进行网格建立，采用有限元方法进行建模获得压力值。血管狭窄远端压力和近端压力的PR≤0.76表示狭窄后残余血流减低。按患者BMI分为低或正常体重组、超重组和肥胖组3组。校正年龄、性别、吸烟史、重度饮酒史、高血压病史、糖尿病病史、血脂异常和狭窄程度这些可能的混杂因素，采用logistic回归分析肥胖与PR减低的关系。
结果共438例患者纳入分析，中位年龄64（57～71）岁，其中148例（33.79%）为女性。低或正常体重组、超重组和肥胖组的中位PR分别为0.90（0.78～0.96）、0.89（0.73～0.96）和0.82（0.52～0.94），3组之间差异有统计学意义（P=0.044）。多因素logistic回归分析结果显示，校正年龄、性别、吸烟史、重度饮酒史、高血压病史、糖尿病病史、血脂异常和狭窄程度，肥胖是sICAS患者PR减低的危险因素（OR 2.551，95%CI 1.328～4.902，P=0.005）。此外，根据年龄进行亚组分析，在≥65岁的患者中，校正性别、吸烟史、重度饮酒史、高血压病史、糖尿病病史、血脂异常和狭窄程度，肥胖是sICAS患者PR减低的危险因素（OR 2.913，95%CI 1.118～7.590，P=0.029）；进行性别亚组分析，女性患者中，校正年龄、高血压病史、糖尿病病史、血脂异常和狭窄程度，肥胖仍是sICAS患者PR减低的危险因素（OR 3.673，95%CI 1.174～11.493，P=0.002）。
结论肥胖可能是sICAS患者PR减低的危险因素。通过减肥是否可以改善sICAS患者PR、增加脑血流灌注需要进一步研究。

关键词: 肥胖; 动脉狭窄; 跨病变压力比; 血流动力学

WANG Anqi, WANG Anxin, ZHANG Yijun, JIANG Yong, ZHANG Yaqing, LIU Li, FU Shengqi, QIN Haiqiang, LIU Gaifen. Relationship between Obesity and Pressure Ratio in Symptomatic Intracranial Atherosclerosis [J]. Chinese Journal of Stroke, 2023, 18(12): 1405-1412.

王安琪, 王安心, 张怡君, 姜勇, 张亚清, 刘丽, 付胜奇, 秦海强, 刘改芬. 肥胖与症状性颅内动脉粥样硬化压力比的关系研究[J]. 中国卒中杂志, 2023, 18(12): 1405-1412.

References

[1] WANG Y，MENG R，LIU G，et al. Intracranial atherosclerotic disease[J/OL]. Neurobiol Dis，2019，124：118-132[2023-06-25]. https://doi.org/10.1016/j.nbd.2018.11.008.
[2] CHIMOWITZ M I，LYNN M J，HOWLETT-SMITH H，et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis[J]. N Engl J Med，2005，352（13）：1305-1316.
[3] LENG X Y，LAN L F，IP H L，et al. Hemodynamics and stroke risk in intracranial atherosclerotic disease[J]. Ann Neurol，2019，85（5）：752-764.
[4] LAN L F，LENG X Y，IP V，et al. Sustaining cerebral perfusion in intracranial atherosclerotic stenosis：the roles of antegrade residual flow and leptomeningeal collateral flow[J]. J Cereb Blood Flow Metab，2020，40（1）：126-134.
[5] SONG X W，QIU H C，WANG S，et al. Hemodynamic and geometric risk factors for in-stent restenosis in patients with intracranial atherosclerotic stenosis[J/OL]. Oxid Med Cell Longev，2022，2022：6951302[2023-06-25]. https://doi.org/10.1155/2022/6951302.
[6] LENG X Y，LAN L F，IP H L，et al. Translesional pressure gradient and leptomeningeal collateral status in symptomatic middle cerebral artery stenosis[J]. Eur J Neurol，2018，25（2）：404-410.
[7] TIAN X，FANG H，LAN L F，et al. Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics[J]. Stroke Vasc Neurol，2023，8（1）：77-85.
[8] QIAO Y S，TANG X Y，CHAI Y H，et al. Cerebral blood flow alterations and obesity：a systematic review and meta-analysis[J]. J Alzheimers Dis，2022，90（1）：15-31.
[9] KNIGHT S P，LAIRD E，WILLIAMSON W，et al. Obesity is associated with reduced cerebral blood flow-modified by physical activity[J/OL]. Neurobiol Aging，2021，105：35-47[2023-06-25]. https://doi.org/10.1016/j.neurobiolaging.2021.04.008.
[10] WILLIAMSON W，LEWANDOWSKI A J，FORKERT N D，et al. Association of cardiovascular risk factors with MRI indices of cerebrovascular structure and function and white matter hyperintensities in young adults[J]. JAMA，2018，320（7）：665-673.
[11] WILLEUMIER K C，TAYLOR D V，AMEN D G. Elevated BMI is associated with decreased blood flow in the prefrontal cortex using SPECT imaging in healthy adults[J]. Obesity（Silver Spring），2011，19（5）：1095-1097.
[12] WANG Y J，JING J，MENG X，et al. The third China National Stroke Registry（CNSR-Ⅲ）for patients with acute ischaemic stroke or transient ischaemic attack：design，rationale and baseline patient characteristics[J]. Stroke Vasc Neurol，2019，4（3）：158-164.
[13] ZHOU B F，Cooperative Meta-Analysis Group of the Working Group on Obesity in China. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults-study on optimal cut-off points of body mass index and waist circumference in Chinese adults[J]. Biomed Environ Sci，2002，15（1）：83-96.
[14] ZHANG J F，MENG X，JING J，et al. Serum calcium and long-term outcome after ischemic stroke：results from the China National Stroke Registry Ⅲ[J/OL]. Atherosclerosis，2021，325：24-29[2023-06-25]. https://doi.org/10.1016/j.atherosclerosis.2021.03.030.
[15] KASNER S E，LYNN M J，CHIMOWITZ M I，et al. Warfarin vs aspirin for symptomatic intracranial stenosis：subgroup analyses from WASID[J]. Neurology，2006，67（7）：1275-1278.
[16] SAMUELS O B，JOSEPH G J，LYNN M J，et al. A standardized method for measuring intracranial arterial stenosis[J]. AJNR Am J Neuroradiol，2000，21（4）：643-646.
[17] CHEN Z M，QIN H Q，LIU J，et al. Characteristics of wall shear stress and pressure of intracranial atherosclerosis analyzed by a computational fluid dynamics model：a pilot study[J/OL]. Front Neurol，2019，10：1372[2023-06-25]. https://doi.org/10.3389/fneur.2019.01372.
[18] LIU J，YAN Z Z，PU Y H，et al. Functional assessment of cerebral artery stenosis：a pilot study based on computational fluid dynamics[J]. J Cereb Blood Flow Metab，2017，37（7）：2567-2576.
[19] YANG P F，WAN S，WANG J，et al. Hemodynamic assessment for intracranial atherosclerosis from angiographic images：a clinical validation study[J/OL]. J Neurointerv Surg，2023：jnis-2023-020073[2023-06-25]. https://doi.org/10.1136/jnis-2023-020073.
[20] TOTH G G，JOHNSON N P，JEREMIAS A，et al. Standardization of fractional flow reserve measurements[J]. J Am Coll Cardiol，2016，68（7）：742-753.
[21] VAN NUNEN L X，ZIMMERMANN F M，TONINO P A L，et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease（FAME）：5-year follow-up of a randomised controlled trial[J]. Lancet，2015，386（10006）：1853-1860.
[22] SUD M，HAN L，KOH M，et al. Association between adherence to fractional flow reserve treatment thresholds and major adverse cardiac events in patients with coronary artery disease[J]. JAMA，2020，324（23）：2406-2414.
[23] TAYLOR C A，FONTE T A，MIN J K. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve：scientific basis[J]. J Am Coll Cardiol，2013，61（22）：2233-2241.
[24] FENG X Y，FANG H，IP B Y M，et al. Cerebral hemodynamics underlying artery-to-artery embolism in symptomatic intracranial atherosclerotic disease[J/OL]. Transl Stroke Res，2023[2023-06-25]. https://doi.org/10.1007/s12975-023-01146-4.
[25] VAN DE HOEF T P，MEUWISSEN M，ESCANED J，et al. Fractional flow reserve as a surrogate for inducible myocardial ischaemia[J]. Nat Rev Cardiol，2013，10（8）：439-452.
[26] HAN Y F，LIU W H，CHEN X L，et al. Severity assessment of intracranial large artery stenosis by pressure gradient measurements：a feasibility study[J]. Catheter Cardiovasc Interv，2016，88（2）：255-261.
[27] SELIM M，JONES R，NOVAK P，et al. The effects of body mass index on cerebral blood flow velocity[J]. Clin Auton Res，2008，18（6）：331-338.
[28] BIRDSILL A C，CARLSSON C M，WILLETTE A A，et al. Low cerebral blood flow is associated with lower memory function in metabolic syndrome[J]. Obesity（Silver Spring），2013，21（7）：1313-1320.
[29] VIRDIS A，MASI S，COLUCCI R，et al. Microvascular endothelial dysfunction in patients with obesity[J/OL]. Curr Hypertens Rep，2019，21（4）：32[2023-06-25]. https://doi.org/10.1007/s11906-019-0930-2.
[30] DORRANCE A M，MATIN N，PIRES P W. The effects of obesity on the cerebral vasculature[J]. Curr Vasc Pharmacol，2014，12（3）：462-472.
[31] FÜLÖP P，HARANGI M，SERES I，et al. Paraoxonase-1 and adipokines：potential links between obesity and atherosclerosis[J/OL]. Chem Biol Interact，2016，259（Pt B）：388-393[2023-06-25]. https://doi.org/10.1016/j.cbi.2016.04.003.
[32] LU S S，GE S，SU C Q，et al. MRI of plaque characteristics and relationship with downstream perfusion and cerebral infarction in patients with symptomatic middle cerebral artery stenosis[J]. J Magn Reson Imaging，2018，48（1）：66-73.
[33] COUCHA M，ABDELSAID M，WARD R，et al. Impact of metabolic diseases on cerebral circulation：structural and functional consequences[J]. Compr Physiol，2018，8（2）：773-799.
[34] OSMOND J M，MINTZ J D，DALTON B，et al. Obesity increases blood pressure，cerebral vascular remodeling，and severity of stroke in the Zucker rat[J]. Hypertension，2009，53（2）：381-386.
[35] NIU J X，RAN Y C，CHEN R，et al. Use of PETRA-MRA to assess intracranial arterial stenosis：comparison with TOF-MRA，CTA，and DSA[J/OL]. Front Neurol，2022，13：1068132[2023-06-25]. https://doi.org/10.3389/fneur.2022.1068132.
[36] ANZIDEI M，NAPOLI A，ZACCAGNA F，et al. Diagnostic accuracy of colour Doppler ultrasonography，CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis：a comparative study with DSA in 170 patients[J]. Radiol Med，2012，117（1）：54-71.