• Andrew B Dicks, Heather L Gornik, Xiaokui Gu, J Michael Bacharach, Fendrikova MahlayNataliaNDepartment of Cardiovascular Medicine Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH., James B Froehlich, Kamal Gupta, Bruce H Gray, KimEsther S HESH0000-0002-3386-6359Division of Cardiovascular Medicine Department of Medicine Vanderbilt University Medical Center Nashville TN., Redah Mahmood, Aditya M Sharma, Bryan J Wells, Jeffrey W Olin, and Ido Weinberg.
• Fireman Vascular Center Massachusetts General Hospital Boston MA.
• J Am Heart Assoc. 2021 Sep 7; 10 (17): e021962.

AbstractBackground Fibromuscular dysplasia (FMD) is a nonatherosclerotic arterial disease that has a variable presentation including pulsatile tinnitus (PT). The frequency and characteristics of PT in FMD are not well understood. The objective of this study was to evaluate the frequency of PT in FMD and compare characteristics between patients with and without PT. Methods and Results Data were queried from the US Registry for FMD from 2009 to 2020. The primary outcomes were frequency of PT among the FMD population and prevalence of baseline characteristics, signs/symptoms, and vascular bed involvement in patients with and without PT. Of 2613 patients with FMD who were included in the analysis, 972 (37.2%) reported PT. Univariable analysis and multivariable logistic regression were performed to explore factors associated with PT. Compared with those without PT, patients with PT were more likely to have involvement of the extracranial carotid artery (90.0% versus 78.6%; odds ratio, 1.49; P=0.005) and to have higher prevalence of other neurovascular signs/symptoms including headache (82.5% versus 62.7%; odds ratio, 1.82; P<0.001), dizziness (44.9% versus 22.9%; odds ratio, 2.01; P<0.001), and cervical bruit (37.5% versus 15.8%; odds ratio, 2.73; P<0.001) compared with those without PT. Conclusions PT is common among patients with FMD. Patients with FMD who present with PT have higher rates of neurovascular signs/symptoms, cervical bruit, and involvement of the extracranial carotid arteries. The coexistence of the 2 conditions should be recognized, and providers who evaluate patients with PT should be aware of FMD as a potential cause.

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