• carotid artery stenosis
• neurocognitive impairment
• cardiovascular risk assessment
• carotid artery imaging

BACKGROUND AND PURPOSE
Vascular dementia (VD) is the second most common form of dementia after Alzheimer’s disease. Potential pathophysiological pathways linking carotid disease with cognitive decline are microembolism, systemic inflammation, and cerebral hypoperfusion. The role of plaque ulceration is still controversial, as well as the role of markers, such as inflammatory biomarkers, lipid profile parameters. Pharmacological therapy may also affect plaque phenotype. We aimed at assessing the prevalence of characteristics related to plaque vulnerability and association of such characteristics with patients’ cardiovascular risk profile, neurocognitive parameters and brain lesions.
METHODS
One hundred-sixty-seven asymptomatic patients with unilateral asymptomatic carotid artery stenosis [40-60% detected by Doppler ultrasound (DUS)], enrolled in the ongoing CAMP study were prospectively evaluated with DUS, Computed Tomography (CT) imaging and Magnetic Resonance Imaging (MRI). Patients were also evaluated with neurocognitive tests. Spearman and Pearson correlation coefficients and Chi-quadrat test were used to calculate the level of agreement between the plaque phenotype (presence or absence of plaque ulceration or other instability characteristics) and various cardiac, vascular, and biochemical markers.
RESULTS
Patients with inhomogeneous plaque at DUS have higher blood pressure (Mean Arterial Pressure in patients with homogeneous plaque 92,185±11,59, Mean Arterial Pressure in patients with inhomogeneous plaque 99,3±0,00, p<0,001) and worse diastolic function (E/A in patients with homogeneous plaque 0,85±0,26, E/A in patients with inhomogeneous plaque 0,65±0,01, p<0,001); patients with plaque microulcerations detected by CT imaging have worse left ventricular systolic function (End stroke volume in patients with non-micro ulcerated plaque 35,87±12,09 End stroke volume in patients with micro ulcerated plaque 44,77±15,50, p=0,009), higher values of Erythrocyte Sedimentation Rate (ESR in patients with micro ulcerated plaque 22,00±13,83 ESR in patients with non-micro ulcerated plaque 14,74±10,71 p=0,036) and a trend in higher values of NT-proBNP (118,92±106,67 in patients with non-micro ulcerated plaque 165,77±124,47 in patients with micro ulcerated plaque p=0,081); patients with intraplaque hemorrhage (IPH) have a worse renal function (creatinine clearance in patients without IPH 73,92±24,28, creatinine clearance in patients with IPH 59,60±12,89, p=0,010), higher heart rate (HR in patients without IPH 65,30±11,50, HR in patients with IPH 76,30±27,18, p=0,027), and lower cardiac index (CI in patients without IPH 2,41±0,66, CI in patients with IPH 1,82±0,94, p=0,015). Neurocognitive tests performances are also correlated with cardiac function parameters. Similarly, brain lesions due to embolic causes are more common in patients with worse left ventricular and renal function.
CONCLUSIONS
Characteristics of intermediate plaque instability detected by multi-imaging multiparametric assessment are mostly related to indexes of cardiac dysfunction, both systolic and diastolic. Neurocognitive tests performances are also correlated with cardiac function, suggesting the role of subclinical heart failure in cognitive decline. The same conclusion could be done for brain embolic lesions since brain lesions due to embolic causes are more common in patients with worse left ventricular and renal function. These findings underline the relevant role of cardiac status in plaque instability, neurocognitive function and brain ischaemic events, and could improve risk stratification and management of patients with carotid artery disease.