Assessment of incidence of cerebral vascular diseases and prediction of stroke risk in chronic obstructive pulmonary disease patients using multimodal biomarkers

Abstract

Background: Early assessment of cerebrovascular disease in chronic obstructive pulmonary disease (COPD) patients is an important issue for a favorable influence on the quality of life.

Methodology: This cross-sectional case-control study was conducted on 38 eligible COPD patients (mean age 55.5 ± 11.5, 25 males, and 13 females) and 26 age-/sex-matched healthy controls. All participants were subjected to stroke risk screening instruments that included the Stroke Riskometer™, the Framingham 10-Year Risk Score, the stroke risk screening tool (the Department of Disease Control of Thailand), the My Risk Stroke Calculator, and Q Stroke. Radiologically, diffusion tensor imaging (DTI) and echo-gradient MRI (T2 star) T2 star imaging were done. Color-coded duplex sonography was done. Laboratory investigations included C-reactive protein (CRP), serum amyloid A, plasma fibrinogen level, serum IL6, 8-Isoprostane, vWF and urinary albumin creatinine ratio.

Results: Stroke risk screening instruments revealed a significant increase in COPD patients. DTI showed a significant bilateral reduction in fractional isotropy and a significant bilateral increase in mean diffusivity of white matter through many areas in COPD patients. Patients also had a significant increase of intima-media thickness, presence of atherosclerotic focal thicknesses or plaques on duplex sonography. There was a significant elevation of CRP, serum amyloid A, plasma fibrinogen level, serum IL6, 8-isoprostane, von Willebrand factor (vWF), and urinary albumin creatinine ratio in COPD patients.

Conclusion: COPD patients had an increased risk for stroke that could be assessed on stroke risk screening instruments, DTI, T2 star, duplex sonography, and laboratory investigation and could be correlated with the severity of the disease.

Keywords: COPD; biomarkers; brain imaging; cerebrovascular disease; duplex; laboratory investigations; stroke risk.

FIGURE 1

Diffusion tensor imaging (DTI) study in chronic obstructive pulmonary disease (COPD) patients with upper panel showing reduced FA in the following from RT to LT side: RT frontal subcortical tract and LT internal capsule; middle panel showing reduced apparent diffusion coefficient (ADC) in the following from RT to LT side: LT temporal lobe and RT parietal lobe; and lower panel showing positioning of the region of interest (ROI) used to measure FA and mean diffusivity (MD) including RT to LT side: RT corticospinal tract and whole tracts

FIGURE 2

MRI study in chronic obstructive pulmonary disease (COPD) patients with tiny low signal foci of hemosiderin of microbleeds in the FLAIR film RT image and T2 star in LT image

FIGURE 3

Duplex ultrasonography study in chronic obstructive pulmonary disease (COPD) patients with upper panel showing increased intima–media thickness (IMT) (about 0.15 cm); the second panel showing homogenous hyperechoic focal thickness in the distal common carotid artery (CCA) measuring 0.36 cm × 0.20 cm, making diameter stenosis 28.3%; and the third panel showing homogenous hyperechoic plaque in the internal carotid artery (ICA) measuring 1.00 cm × 0.54 cm, making diameter stenosis 55%