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  • Association of homocysteine and smoking with cerebral microemboli in patients with mechanical heart valves: a transcranial Doppler study

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Original article
Association of homocysteine and smoking with cerebral microemboli in patients with mechanical heart valves: a transcranial Doppler study
  1. Alicia Mattia1,2,
  2. M Reza Azarpazhooh3,4,
  3. Claudio Munoz1,
  4. Chrysi Bogiatzi1,2,
  5. Mackenzie A Quantz5,
  6. J David Spence1,4,6
  1. 1 Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
  2. 2 Department of Neurology, McMaster University, Hamilton, Ontario, Canada
  3. 3 Division of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  4. 4 Division of Neurology, Western University, London, Ontario, Canada
  5. 5 Division of Cardiac Surgery, Western University, London, Ontario, Canada
  6. 6 Division of Clinical Pharmacology, Western University, London, Ontario, Canada
  1. Correspondence to Professor J David Spence, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON N6G 2V4, Canada; dspence{at}robarts.ca

Abstract

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.

  • homocysteine
  • mechanical heart valves
  • valvular heart disease
  • microembolic signal detection
  • transcranial doppler ultrasound

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/svn-2017-000117

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    Footnotes

    • Contributors JDS conceived of the study, analysed data, and wrote revisions of the manuscript and the final draft. AM, CB and MAQ recruited patients. AM collected and analysed data. CM performed the transcranial Doppler studies. MRA conducted analyses of the data.

    • Funding The study was funded by donations to the Stroke Prevention & Atherosclerosis Research Centre, mainly from patients attending the stroke prevention clinics.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The protocol was approved on 20 March 2014 by the Human Subjects Research Ethics Research Board of the University of Western Ontario (protocol number 103490).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Unpublished data could be provided upon request.