A multicenter study of ultrasound assessment of the diameter differences due to vertebral artery dominance and its association with vertebral artery origin stenosis
10.3969/j.issn.1672-5921.2024.11.004
- VernacularTitle:超声评估椎动脉优势所致管径不对称程度与椎动脉起始段狭窄相关性的多中心研究
- Author:
Yiming LIU
1
;
Feng ZHANG
;
Yang HUA
;
Carotid Artery Ultrasound Project Group(CAUPC)
Author Information
1. 510655 广州,中山大学附属第六医院超声科
- Keywords:
Vertebral artery;
Ultrasonography;
Vertebral artery origin stenosis;
Vertebral artery dominance;
Asymmetry
- From:
Chinese Journal of Cerebrovascular Diseases
2024;21(11):744-751
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the association between vertebral artery origin stenosis(VAOS)and the degree of bilateral vertebral artery diameter asymmetry caused by vertebral artery dominance(VAD)in patients cardiovascular and cerebrovascular disease risk factors and the optimal diameter difference(△D)cutoff value for diagnosing VAD.Methods A total of 6 404 subjects without vertebral artery occlusion and risks factors of cerebrovascular disease including hyperlipidemia,hypertension,diabetes,obesity(body mass index[BMI]≥ 28 kg/m2),smoking history,and drinking history were retrospectively enrolled from the Standardized Evaluation Database for Screening of High-risk Groups for Stroke from December 2019 to December 2021.The age,sex,BMI,bilateral vertebral artery△D,and VAOS evaluated by the systolic peak velocity and end-diastolic velocity of the vertebral artery origin and intervertebral segment were collected.Subjects with stenosis rate≥50％were divided into VAOS group,and the rest were divided into control group.The general data and △D of the two groups were compared.The items with statistically significant differences were enrolled into multivariable Logistic regression analysis in which ≥50％VAOS was used as the dependent variable.The VAOS group and the control group were matched at a ratio of 1∶5 using propensity score matching.The receiver operating characteristic(ROC)curve was drawn based on ≥50％VAOS as the outcome indicator and △D as the independent variable after matching.The area under the curve(AUC)was calculated.The Youden index was used to calculate the optimal cutoff value of △D.Results Among the 6 404 patients included,there were 1 975 males and 4 429 females.Among them,46 patients were in the VAOS group,and the incidence of VAOS was 0.72％.(1)The results of univariate Logistic regression analysis showed that the male proportion,age,BMI and △D in the VAOS group were higher than those in the control group(P＜0.05).The above variables were further included in the multivariate Logistic regression analysis and the results showed that male(OR,2.49,95％CI 1.36-4.67,P=0.003),age(OR,1.14,95％CI 1.11-1.17,P＜0.01)and △ D(OR,1.81,95％CI 1.06-2.97,P=0.024)were risk factors for VAOS.(2)After propensity score matching,46 cases were included in the VAOS group and 230 cases were included in the control group,for a total of 276 cases.The inter-group comparison showed that the △D in the VAOS group was higher than that in the control group(0.65[0.30,1.20]mm vs.0.40[0.20,0.80]mm,P=0.009).There were no significant differences in the other baseline data between the groups(P＞0.05).(3)Based on 276 subjects matched by propensity score,the ROC curve analysis with the occurrence of VAOS as the outcome indicator and △D as the independent variable showed that the AUC of △D for predicting ≥50％VAOS was 0.622,the optimal cutoff value was 0.800 mm,the specificity was 78.3％,and the sensitivity was 41.3％.Conclusions The difference in the diameter of the bilateral vertebral arteries in patients without cardiovascular and cerebrovascular disease risk factors is associated with the occurrence of ≥50％VAOS.The optimal cutoff value of the diameter difference is 0.800 mm,which can be used as a reference standard for defining VAD.The diameter difference 0.800mm indicates a higher risk of VAOS with stenosis rate ≥50％(specificity 78.3％,sensitivity 41.3％).The results of this study need to be further verified.
