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Useful Method to Monitor Cerebral Infarction in Atherosclerotic Patients without Atrial Fibrillation by the Combination of Carotid Intima-Media Thickness, Cardio-Ankle Vascular Index, and Plasma D-dimer

Shigeru Hayashi

Background and aims: To devise an effective monitoring system for detecting cerebral infarction in severely atherosclerotic patients without atrial fibrillation.

Methods: Atherosclerotic patients (284 cases; men: 97, women: 187; age: 35-96 years old; mean: 71.6 ± 10.7 years old) comprising hypertension, hyperlipidemia, lacunar infarction, ischemic heart disease, and diabetes mellitus, were enrolled and the occurrence of symptomatic cerebral infarction was observed for 40 months. They were stratified into mildly (A) (CAVI<8.0, IMT8.0, IMT>1.1 mm) atherosclerotic groups based on the level of CAVI and IMT and further divided into 2 subgroups: B, D+ (CAVI>8.0, IMT>1.1 mm, Ddimer> 1.0 μg/mL) and B, D- (CAVI>8.0, IMT>1.1 mm, D-dimer

Results: The incidence of cerebral infarction in group A was 0% (0/60), while that in group B was 5.9% (5/84), showing no significance (Chi-square test). Moreover, we examined the incidence of cerebral infarction in the two subgroups, revealing that in subgroup D, B+ it was 31.3% (5/16), while that in subgroup B, D- was 0/73 (Chi-square test, p<0.0001). The rate of aspirin intake in subgroup B, D+ was 43.8% (7/16), while that in subgroup B, D- was 45.2% (33/73), suggesting that the difference in aspirin use was not significant (Chi-square test).

Conclusion: The combination of CAVI, IMT and D-dimer was a useful tool for detecting cerebral infarction in atherosclerotic patients without atrial fibrillation.The incidence of cerebral infarction was increased in severely atherosclerotic patients with a high level of plasma D-dimer.