RT Journal Article
SR Electronic
T1 Association of homocysteine and smoking with cerebral microemboli in patients with mechanical heart valves: a transcranial Doppler study
JF Stroke and Vascular Neurology
FD BMJ Publishing Group Ltd
SP svn-2017-000117
DO 10.1136/svn-2017-000117
A1 Alicia Mattia
A1 M Reza Azarpazhooh
A1 Claudio Munoz
A1 Chrysi Bogiatzi
A1 Mackenzie A Quantz
A1 J David Spence
YR 2017
UL http://svn.bmj.com/content/early/2017/11/16/svn-2017-000117.abstract
AB Objectives Microembolic signals (MES) on transcranial Doppler (TCD) predict stroke and cognitive decline. Plasma levels of total homocysteine (tHcy), a prothrombotic factor, are higher in patients with microemboli in carotid stenosis and in patients with paradoxical embolism. In this study we assessed the association between the level of tHcy and the number of MES in patients with mechanical heart valves (MHVs).Methods TCD monitoring was performed to detect MES before and after breathing 100% oxygen and repeated every 2–4 weeks up to six times.Results Twenty-five patients with MHVs (mean age: 63.60±10.15 years) participated in this study; 15 were men (66.47±7.25 years) and 10 were women (59.30±12.60 years). In total, there were 126 study visits. In multiple regression, higher tHcy was associated with more MES in both preoxygenation (OR 1.34 (95% CI 1.07 to 1.68, P=0.009)) and postoxygenation (OR 1.40 (95% CI 1.07 to 1.83, P=0.01)) phases. Current smoking and the length of time between the operation and monitoring also correlated with a higher number of MES before and after breathing oxygen, particularly in women.Conclusions Higher tHcy and smoking were associated with a higher MES count in both preoxygenation and postoxygenation phases. Because smoking can be stopped and hyperhomocysteinaemia is treatable, these are clinically important findings.