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Walsh HJ, Junejo RT, Lip GYH, Fisher JP. The effect of hypertension on cerebrovascular carbon dioxide reactivity in atrial fibrillation patients. Hypertens Res 2024; 47:1678-1687. [PMID: 38600276 PMCID: PMC11150149 DOI: 10.1038/s41440-024-01662-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
Atrial fibrillation (AF) and hypertension (HTN) are both associated with impaired cerebrovascular carbon dioxide reactivity (CVRCO2), an indicator of cerebral vasodilatory reserve. We hypothesised that CVRCO2 would be lower in patients with both AF and HTN (AF + HTN) compared to normotensive AF patients, due to an additive effect of AF and HTN on CVRCO2. Forty AF (68 ± 9 years) and fifty-seven AF + HTN (68 ± 8 years) patients underwent transcranial Doppler ultrasound measurement of middle cerebral artery blood velocity (MCA Vm) during stepped increases and decreases in end-tidal carbon dioxide (PETCO2). A cerebrovascular conductance index (CVCi) was calculated as the ratio of MCA Vm and mean arterial pressure (MAP). CVRCO2 was determined from the linear slope for MCA Vm and MCA CVCi vs PETCO2. Baseline MAP was higher in AF + HTN than AF (107 ± 9 vs. 98 ± 9 mmHg, respectively; p < 0.001), while MCA Vm was not different (AF + HTN:49.6 [44.1-69.0]; AF:51.7 [45.2-63.3] cm.s-1; p = 0.075), and CVCi was lower in AF + HTN (0.46 [0.42-0.57] vs. 0.54 [0.44-0.63] cm.s-1.mmHg-1; p < 0.001). MCA Vm CVRCO2 was not different (AF + HTN: 1.70 [1.47-2.19]; AF 1.74 [1.54-2.52] cm/s/mmHg-2; p = 0.221), while CVCi CVRCO2 was 13% lower in AF + HTN (0.013 ± 0.004 vs 0.015 ± 0.005 cm.s-1.mmHg-1; p = 0.047). Our results demonstrate blunted cerebral vasodilatory reserve (determined as MCA CVCi CVRCO2) in AF + HTN compared to AF alone. This may implicate HTN as a driver of further cerebrovascular dysfunction in AF that may be important for the development of AF-related cerebrovascular events and downstream cognitive decline. We demonstrated reduced cerebrovascular CO2 responsiveness in atrial fibrillation with hypertension (AF+HTN) vs. atrial fibrillation (AF). Furthermore, AF per se (as opposed to normal sinus rhythm) predicts reduced cerebrovascular CO2 responsiveness. Our findings suggest additional cerebrovascular dysfunction in AF+HTN vs. AF.
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Affiliation(s)
- Harvey J Walsh
- Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rehan T Junejo
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - James P Fisher
- Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
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2
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Wen D, Xu Y. Comprehensive investigations of cerebral hemodynamic responses in CSVD patients with mental disorders: a pilot study. Front Psychiatry 2023; 14:1229436. [PMID: 37795515 PMCID: PMC10546028 DOI: 10.3389/fpsyt.2023.1229436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
Although a portion of patients with cerebral small vessel disease (CSVD) present mental disorders, there is currently a lack of appropriate technologies to evaluate brain functions that are relevant to neurovascular coupling. Furthermore, there are no established objective criteria for diagnosing and distinguishing CSVD-induced mental disorders and psychiatric diseases. In this study, we report the first comprehensive investigation of the cerebral hemodynamics of CSVD patients who also presented with mental disorders. Two CSVD patients with similar magnetic resonance imaging (MRI) outcomes but with non-identical mental symptoms participated in this study. The patients were instructed to perform the verbal fluency task (VFT), high-level cognition task (HCT), as well as voluntary breath holding (VBH). A functional near-infrared spectroscopy (fNIRS) was used to measure the cerebral oxygenation responses. Additionally, a diffuse correlation spectroscopy (DCS) was used to measure the cerebral blood flow (CBF) responses. Both technologies were also applied to a healthy subject for comparison. The fNIRS results showed that both CSVD patients presented abnormal cerebral oxygenation responses during the VFT, HCT, and VBH tasks. Moreover, the patient with cognition impairment showed fluctuations in CBF during these tasks. In contrast, the patient without cognition impairment mostly presented typical CBF responses during the tasks, which was consistent with the healthy subject. The cognitive impairment in CSVD patients may be due to the decoupling of the neurons from the cerebrovascular, subsequently affecting the autoregulation capacity. The results of the fNIRS and DCS combined provide a comprehensive evaluation of the neurovascular coupling and, hence, offer great potential in diagnosing cerebrovascular or psychiatric diseases.
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Affiliation(s)
- Dan Wen
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Psychiatry, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yong Xu
- Department of Psychiatry, Shanxi Medical University, Taiyuan, Shanxi, China
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3
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Skow RJ, Brothers RM, Claassen JAHR, Day TA, Rickards CA, Smirl JD, Brassard P. On the use and misuse of cerebral hemodynamics terminology using Transcranial Doppler ultrasound: a call for standardization. Am J Physiol Heart Circ Physiol 2022; 323:H350-H357. [PMID: 35839156 DOI: 10.1152/ajpheart.00107.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cerebral hemodynamics (e.g., cerebral blood flow) can be measured and quantified using many different methods, with Transcranial Doppler ultrasound (TCD) being one of the most commonly utilized approaches. In human physiology, the terminology used to describe metrics of cerebral hemodynamics are inconsistent, and in some instances technically inaccurate; this is especially true when evaluating, reporting, and interpreting measures from TCD. Therefore, this perspectives article presents recommended terminology when reporting cerebral hemodynamic data. We discuss the current use and misuse of the terminology in the context of using TCD to measure and quantify cerebral hemodynamics and present our rationale and consensus on the terminology that we recommend moving forward. For example, one recommendation is to discontinue use of the term "cerebral blood flow velocity" in favor of "cerebral blood velocity" with precise indication of the vessel of interest. We also recommend clarity when differentiating between discrete cerebrovascular regulatory mechanisms, namely cerebral autoregulation, neurovascular coupling, and cerebrovascular reactivity. This will be a useful guide for investigators in the field of cerebral hemodynamics research.
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Affiliation(s)
- Rachel J Skow
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| | - Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Caroline A Rickards
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Jonathan D Smirl
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Canada
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4
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Baker J, Safarzadeh MA, Incognito AV, Jendzjowsky NG, Foster GE, Bird JD, Raj SR, Day TA, Rickards CA, Zubieta-DeUrioste N, Alim U, Wilson RJA. Functional optical coherence tomography at altitude: retinal microvascular perfusion and retinal thickness at 3,800 meters. J Appl Physiol (1985) 2022; 133:534-545. [PMID: 35771223 DOI: 10.1152/japplphysiol.00132.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral hypoxia is a serious consequence of several cardiorespiratory illnesses. Measuring the retinal microvasculature at high altitude provides a surrogate for cerebral microvasculature, offering potential insight into cerebral hypoxia in critical illness. Additionally, while sex-specific differences in cardiovascular diseases are strongly supported, few have focused on differences in ocular blood flow. We evaluated the retinal microvasculature in males (n=11) and females (n=7) using functional optical coherence tomography at baseline (1,130m) (Day 0), following rapid ascent (Day 2) and prolonged exposure (Day 9) to high altitude (3,800m). Retinal vascular perfusion density (rVPD; an index of total blood supply), retinal thickness (RT; reflecting vascular and neural tissue volume) and arterial blood were acquired. As a group, rVPD increased on Day 2 vs. Day 0 (p<0.001) and was inversely related to PaO2 (R2=0.45; p=0.006). By Day 9, rVPD recovered to baseline, but was significantly lower in males vs. females (p=0.007). RT was not different on Day 2 vs. Day 0 (p>0.99) but was reduced by Day 9 relative to Day 0 and Day 2 (p<0.001). RT changes relative to Day 0 were inversely related to changes in PaO2 on Day 2 (R2=0.6; p=0.001) and Day 9 (R2=0.4; p=0.02). RT did not differ between sexes. These data suggest differential time course and regulation of the retina during rapid ascent and prolonged exposure to high altitude and are the first to demonstrate sex-specific differences in rVPD at high altitude. The ability to assess intact microvasculature contiguous with the brain has widespread research and clinical applications.
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Affiliation(s)
- Jacquie Baker
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Mohammad Amin Safarzadeh
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anthony V Incognito
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nicholas G Jendzjowsky
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
| | - Glen Edward Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Jordan D Bird
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Caroline A Rickards
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Natalia Zubieta-DeUrioste
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,High Altitude Pulmonary and Pathology Institute (HAPPI - IPPA), La Paz, Bolivia
| | - Usman Alim
- Department of Computer Science, University of Calgary, Calgary, Alberta, Canada
| | - Richard J A Wilson
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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5
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Marullo AL, Bruce CD, Pfoh JR, Chauhan UV, Abrosimova M, Berg ERV, Skow RJ, Davenport MH, Strzalkowski NDJ, Steinback CD, Day TA. Cerebrovascular and blood pressure responses during voluntary apneas are larger than rebreathing. Eur J Appl Physiol 2022; 122:735-743. [PMID: 34978604 DOI: 10.1007/s00421-021-04864-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Both voluntary rebreathing (RB) of expired air and voluntary apneas (VA) elicit changes in arterial carbon dioxide and oxygen (CO2 and O2) chemostimuli. These chemostimuli elicit synergistic increases in cerebral blood flow (CBF) and sympathetic nervous system activation, with the latter increasing systemic blood pressure. The extent that simultaneous and inverse changes in arterial CO2 and O2 and associated increases in blood pressure affect the CBF responses during RB versus VAs are unclear. We instrumented 21 healthy participants with a finometer (beat-by-beat mean arterial blood pressure; MAP), transcranial Doppler ultrasound (middle and posterior cerebral artery velocity; MCAv, PCAv) and a mouthpiece with sample line attached to a dual gas analyzer to assess pressure of end-tidal (PET)CO2 and PETO2. Participants performed two protocols: RB and a maximal end-inspiratory VA. A second-by-second stimulus index (SI) was calculated as PETCO2/PETO2 during RB. For VA, where PETCO2 and PETO2 could not be measured throughout, SI values were calculated using interpolated end-tidal gas values before and at the end of the apneas. MAP reactivity (MAPR) was calculated as the slope of the MAP/SI, and cerebrovascular reactivity (CVR) was calculated as the slope of MCAv or PCAv/SI. We found that compared to RB, VA elicited ~ fourfold increases in MAPR slope (P < 0.001), translating to larger anterior and posterior CVR (P ≤ 0.01). However, cerebrovascular conductance (MCAv or PCAv/MAP) was unchanged between interventions (P ≥ 0.2). MAP responses during VAs are larger than those during RB across similar chemostimuli, and differential CVR may be driven by increases in perfusion pressure.
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Affiliation(s)
- Anthony L Marullo
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Christina D Bruce
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Jamie R Pfoh
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Uday V Chauhan
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Maria Abrosimova
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Emily R Vanden Berg
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Rachel J Skow
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Margie H Davenport
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Nicholas D J Strzalkowski
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada
| | - Craig D Steinback
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada.
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6
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Keough JRG, Cates VC, Tymko MM, Boulet LM, Jamieson AN, Foster GE, Day TA. Regional differences in cerebrovascular reactivity in response to acute isocapnic hypoxia in healthy humans: Methodological considerations. Respir Physiol Neurobiol 2021; 294:103770. [PMID: 34343693 DOI: 10.1016/j.resp.2021.103770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/15/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
The cerebrovasculature responds to blood gas challenges. Regional differences (anterior vs. posterior) in cerebrovascular responses to increases in CO2 have been extensively studied. However, regional cerebrovascular reactivity (CVR) responses to low O2 (hypoxia) are equivocal, likely due to differences in analysis. We assessed the effects of acute isocapnic hypoxia on regional CVR comparing absolute and relative (%-change) responses in the middle cerebral artery (MCA) and posterior cerebral artery (PCA). We instrumented 14 healthy participants with a transcranial Doppler ultrasound (cerebral blood velocity), finometer (beat-by-beat blood pressure), dual gas analyzer (end-tidal CO2 and O2), and utilized a dynamic end-tidal forcing system to elicit a single 5-min bout of isocapnic hypoxia (∼45 Torr PETO2, ∼80 % SpO2). During exposure to acute hypoxia, absolute responses were larger in the anterior compared to posterior cerebral circulation (P < 0.001), but were not different when comparing relative responses (P = 0.45). Consistent reporting of CVR to hypoxia will aid understanding normative responses, particularly in assessing populations with impaired cerebrovascular function.
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Affiliation(s)
- Joanna R G Keough
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Valerie C Cates
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Michael M Tymko
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey M Boulet
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada; Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Alenna N Jamieson
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Glen E Foster
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada.
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7
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Keough JRG, Tymko MM, Boulet LM, Jamieson AN, Day TA, Foster GE. Cardiorespiratory plasticity in humans following two patterns of acute intermittent hypoxia. Exp Physiol 2021; 106:1524-1534. [PMID: 34047414 DOI: 10.1113/ep089443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/25/2021] [Indexed: 01/02/2023]
Abstract
NEW FINDINGS What is the central question of this study? Do cardiorespiratory experience-dependent effects (EDEs) differ between two different stimulus durations of acute isocapnic intermittent hypoxia (IHx; 5-min vs. 90-s cycles between hypoxia and normoxia)? What is the main finding and its importance? There was long-term facilitation in ventilation and blood pressure in both IHx protocols, but there was no evidence of progressive augmentation or post-hypoxia frequency decline. Not all EDEs described in animal models translate to acute isocapnic IHx responses in humans, and cardiorespiratory responses to 5-min versus 90-s on/off IHx protocols are largely similar. ABSTRACT Peripheral respiratory chemoreceptors monitor breath-by-breath changes in arterial CO2 and O2 , and mediate ventilatory changes to maintain homeostasis. Intermittent hypoxia (IHx) elicits hypoxic ventilatory responses, with well-described experience-dependent effects (EDEs), derived mostly from animal work involving intermittent 5-min cycles of hypoxia and normoxia. These EDEs include post-hypoxia frequency decline (PHxFD), progressive augmentation (PA) and long-term facilitation (LTF). Comparisons of these EDEs between animal models and humans using similar IHx protocols are lacking. In addition, it is unknown whether shorter bouts of hypoxia, which may be more relevant to clinical conditions, elicit EDEs of similar magnitudes in humans. Respiratory (frequency, tidal volume and minute ventilation ( V ̇ I ) and cardiovascular (heart rate and mean arterial pressure (MAP)) variables were measured during and following two patterns of acute isocapnic IHx in 14 healthy human participants (four female): (1) 5 × 5 min and (2) 5 × 90 s on/off hypoxia. Participants' end-tidal P O 2 was clamped at 45 Torr during hypoxia and 100 Torr during normoxia. We found that (1) PHxFD and PA were not present in either IHx pattern (P > 0.14), (2) LTF was present in V ̇ I following both 5-min (P < 0.001) and 90-s isocapnic IHx trials (P < 0.001), and (3) LTF was present in MAP following 5-min isocapnic IHx (P < 0.001), and trended towards significance following 90-s IHx (P = 0.058). We demonstrate that acute isocapnic IHx alone may not elicit all of the EDEs that have been described in animal models. Additionally, ventilatory LTF occurred regardless of the length of hypoxia-normoxia cycles.
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Affiliation(s)
- Joanna R G Keough
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Michael M Tymko
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada.,Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey M Boulet
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Alenna N Jamieson
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Glen E Foster
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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Friend AT, Rogan M, Rossetti GMK, Lawley JS, Mullins PG, Sandoo A, Macdonald JH, Oliver SJ. Bilateral regional extracranial blood flow regulation to hypoxia and unilateral duplex ultrasound measurement error. Exp Physiol 2021; 106:1535-1548. [PMID: 33866627 DOI: 10.1113/ep089196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/14/2021] [Indexed: 02/05/2023]
Abstract
NEW FINDINGS What is the central question of this study? Is blood flow regulation to hypoxia different between the internal carotid arteries (ICAs) and vertebral arteries (VAs), and what is the measurement error in unilateral extracranial artery assessments compared to bilateral? What is the main finding and its importance? ICA and VA blood flow regulation to hypoxia is comparable when factoring for vessel type and vessel side. Compared to bilateral assessment, vessels assessed unilaterally had individual measurement errors of up to 37%. Assessing the vessel with the larger resting blood flow, not the left or right vessel, reduces unilateral measurement error. ABSTRACT Whether blood flow regulation to hypoxia is similar between left and right internal carotid arteries (ICAs) and vertebral arteries (VAs) is unclear. Extracranial blood flow is regularly calculated by doubling a unilateral assessment; however, lateral artery differences may lead to measurement error. This study aimed to determine extracranial blood flow regulation to hypoxia when factoring for vessel type (ICAs or VAs) and vessel side (left or right) effects, and to investigate unilateral assessment measurement error compared to bilateral assessment. In a repeated-measures crossover design, extracranial arteries of 44 participants were assessed bilaterally by duplex ultrasound during 90 min of normoxic and poikilocapnic hypoxic (12.0% fraction of inspired oxygen) conditions. Linear mixed model analyses revealed no Condition × Vessel Type × Vessel Side interaction for blood flow, vessel diameter and flow velocity (all P > 0.05) indicating left and right ICA and VA blood flow regulation to hypoxia was similar. Bilateral hypoxic reactivity was comparable (ICAs, 1.4 (1.0) vs. VAs, 1.7 (1.1) Δ%·Δ S p O 2 -1 ; P = 0.12). Compared to bilateral assessment, unilateral mean measurement error of the relative blood flow response to hypoxia was up to 5%, but individual errors reached 37% and were greatest in ICAs and VAs with the smaller resting blood flow due to a ratio-scaling problem. In conclusion, left and right ICA and VA regulation to hypoxia is comparable when factoring for vessel type and vessel side. Assessing the ICA and VA vessels with the larger resting blood flow, not the left or right vessel, reduces unilateral measurement error.
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Affiliation(s)
- Alexander T Friend
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Matthew Rogan
- Bangor Imaging Unit, School of Psychology, College of Human Sciences, Bangor University, Bangor, UK
| | - Gabriella M K Rossetti
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK.,Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Justin S Lawley
- Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria
| | - Paul G Mullins
- Bangor Imaging Unit, School of Psychology, College of Human Sciences, Bangor University, Bangor, UK
| | - Aamer Sandoo
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Jamie H Macdonald
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK
| | - Samuel J Oliver
- Extremes Research Group, School of Sport, Health and Exercise Sciences, College of Human Sciences, Bangor University, Bangor, UK
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9
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Labrecque L, Drapeau A, Rahimaly K, Imhoff S, Brassard P. Dynamic cerebral autoregulation and cerebrovascular carbon dioxide reactivity in middle and posterior cerebral arteries in young endurance-trained women. J Appl Physiol (1985) 2021; 130:1724-1735. [PMID: 33955257 DOI: 10.1152/japplphysiol.00963.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The integrated responses regulating cerebral blood flow are understudied in women, particularly in relation to potential regional differences. In this study, we compared dynamic cerebral autoregulation (dCA) and cerebrovascular reactivity to carbon dioxide (CVRco2) in the middle (MCA) and posterior cerebral arteries (PCA) in 11 young endurance-trained women (age, 25 ± 4 yr; maximal oxygen uptake, 48.1 ± 4.1 mL·kg-1·min-1). dCA was characterized using a multimodal approach including a sit-to-stand and a transfer function analysis (TFA) of forced blood pressure oscillations (repeated squat-stands executed at 0.05 Hz and 0.10 Hz). The hyperoxic rebreathing test was utilized to characterize CVRco2. Upon standing, the percent reduction in blood velocity per percent reduction in mean arterial pressure during initial orthostatic stress (0-15 s after sit-to-stand), the onset of the regulatory response, and the rate of regulation did not differ between MCA and PCA (all P > 0.05). There was an ANOVA effect of anatomical location for TFA gain (P < 0.001) and a frequency effect for TFA phase (P < 0.001). However, normalized gain was not different between arteries (P = 0.18). Absolute CVRco2 was not different between MCA and PCA (1.55 ± 0.81 vs. 1.30 ± 0.49 cm·s-1/Torr, P = 0.26). Relative CVRco2 was 39% lower in the MCA (2.16 ± 1.02 vs. 3.00 ± 1.09%/Torr, P < 0.01). These findings indicate that the cerebral pressure-flow relationship appears to be similar between the MCA and the PCA in young endurance-trained women. The absence of regional differences in absolute CVRco2 could be women specific, although a direct comparison with a group of men will be necessary to address that issue.NEW & NOTEWORTHY Herein, we describe responses from two major mechanisms regulating cerebral blood flow with a special attention on regional differences in young endurance-trained women. The novel findings are that dynamic cerebral autoregulation and absolute cerebrovascular reactivity to carbon dioxide appear similar between the middle and posterior cerebral arteries of these young women.
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Affiliation(s)
- Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada
| | - Audrey Drapeau
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada
| | - Kevan Rahimaly
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada
| | - Sarah Imhoff
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada.,Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada
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10
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Qin L, Li N, Tong J, Hao Z, Wang L, Zhao Y. Impact of mandibular advancement device therapy on cerebrovascular reactivity in patients with carotid atherosclerosis combined with OSAHS. Sleep Breath 2021; 25:1543-1552. [PMID: 33415656 DOI: 10.1007/s11325-020-02230-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/04/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Obstructive sleep apnea-hypopnea syndrome (OSAHS) may affect cerebrovascular reactivity (CVR), representing cerebrovascular endothelial function, through complex cerebral functional changes. This study aimed to evaluate the change of CVR after 1-month and 6-month mandibular advancement device (MAD) treatment of patients with carotid atherosclerosis (CAS) combined with OSAHS. METHODS Patients with carotid atherosclerosis combined with OSAHS who voluntarily accepted Silensor-IL MAD therapy were prospectively enrolled. All patients underwent polysomnographic (PSG) examinations and CVR evaluation by breath-holding test using transcranial Doppler ultrasound at baseline (T0), 1 month (T1), and 6 months (T2) of MAD treatment. RESULTS Of 46 patients (mean age 54.4 ± 12.4 years, mean body mass index [BMI] 27.5 ± 4.5 kg/m2), 41 patients (responsive group) responded to the 1-month and 6-month treatment of MAD, an effective treatment rate of 89%. The remaining 5 patients (non-responsive group) were younger (47.4 ± 13.5 years) and had a higher BMI (35.8 ± 1.8 kg/m2). The responsive group had an improvement of apnea-hypopnea index (AHI) (events/h) from 33.0 ± 25.0 (T0) to 12.4 ± 10.4 (T1) and 8.7 ± 8.8 (T2), P < 0.001; minimum arterial oxygen saturation (minSpO2) (%) increased from 79.8 ± 9.1 (T0) to 81.8 ± 9.4 (T1) and 85.2 ± 5.4 (T2), P < 0.01; longest apnea (LA) (s) decreased from 46.5 ± 23.1 (T0) to 33.3 ± 22.7 (T1) and 29.4 ± 18.5 (T2), P < 0.001; T90 (%) decreased from 10.3 ± 14.9 (T0) to 6.1 ± 11.8 (T1) and 3.3 ± 7.5 (T2), P < 0.05. Sleep architecture of these patients also improved significantly. The responsive group had a significant increase in left, right, and mean breath-holding index (BHI): left BHI(/s) from 0.52 ± 0.42 (T0) to 0.94 ± 0.56 (T1) and 1.04 ± 0.64 (T2), P < 0.01; right BHI(/s) from 0.60 ± 0.38 (T0) to 1.01 ± 0.58 (T1) and 1.11 ± 0.60 (T2), P < 0.01; mean BHI(/s) from 0.56 ± 0.38 (T0) to 0.97 ± 0.55 (T1) and 1.07 ± 0.59 (T2), P < 0.01), suggesting improved CVR. CONCLUSION Effective MAD therapy is beneficial for restoring cerebrovascular endothelial function in patients with CAS and OSAHS in a short period (1 month and 6 months). TRIAL REGISTRATION Clinical trial registration number: NCT03665818. September 11, 2018.
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Affiliation(s)
- Lu Qin
- Department of Dentistry, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China
| | - Na Li
- Department of Vascular Ultrasound, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China
| | - Junyao Tong
- Department of Dentistry, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China
| | - Zeliang Hao
- Department of Dentistry, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China
| | - Lili Wang
- Department of Vascular Ultrasound, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China
| | - Ying Zhao
- Department of Dentistry, Xuanwu Hospital Capital Medical University, #45 Xicheng District, Beijing, 100053, China.
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11
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Bruce CD, Vanden Berg ER, Pfoh JR, Steinback CD, Day TA. Prior oxygenation, but not chemoreflex responsiveness, determines breath-hold duration during voluntary apnea. Physiol Rep 2021; 9:e14664. [PMID: 33393725 PMCID: PMC7780234 DOI: 10.14814/phy2.14664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 01/24/2023] Open
Abstract
Central and peripheral respiratory chemoreceptors are stimulated during voluntary breath holding due to chemostimuli (i.e., hypoxia and hypercapnia) accumulating at the metabolic rate. We hypothesized that voluntary breath-hold duration (BHD) would be (a) positively related to the initial pressure of inspired oxygen prior to breath holding, and (b) negatively correlated with respiratory chemoreflex responsiveness. In 16 healthy participants, voluntary breath holds were performed under three conditions: hyperoxia (following five normal tidal breaths of 100% O2 ), normoxia (breathing room air), and hypoxia (following ~30-min of 13.5%-14% inspired O2 ). In addition, the hypoxic ventilatory response (HVR) was tested and steady-state chemoreflex drive (SS-CD) was calculated in room air and during steady-state hypoxia. We found that (a) voluntary BHD was positively related to initial oxygen status in a dose-dependent fashion, (b) the HVR was not correlated with BHD in any oxygen condition, and (c) SS-CD magnitude was not correlated with BHD in normoxia or hypoxia. Although chemoreceptors are likely stimulated during breath holding, they appear to contribute less to BHD compared to other factors such as volitional drive or lung volume.
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Affiliation(s)
- Christina D. Bruce
- Department of BiologyFaculty of Science and TechnologyMount Royal UniversityCalgaryABCanada
- School of Health and Exercise SciencesCentre for Heart, Lung and Vascular HealthFaculty of Health and Social DevelopmentUniversity of British ColumbiaKelownaBCCanada
| | - Emily R. Vanden Berg
- Department of BiologyFaculty of Science and TechnologyMount Royal UniversityCalgaryABCanada
- Department of BiologyFaculty of ScienceUniversity of VictoriaVictoriaBCCanada
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
| | - Jamie R. Pfoh
- Department of BiologyFaculty of Science and TechnologyMount Royal UniversityCalgaryABCanada
| | - Craig D. Steinback
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
| | - Trevor A. Day
- Department of BiologyFaculty of Science and TechnologyMount Royal UniversityCalgaryABCanada
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12
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Koep JL, Barker AR, Banks R, Banger RR, Sansum KM, Weston ME, Bond B. The reliability of a breath-hold protocol to determine cerebrovascular reactivity in adolescents. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:544-552. [PMID: 32608099 DOI: 10.1002/jcu.22891] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Cerebrovascular reactivity (CVR) is impaired in adolescents with cardiovascular disease risk factors. A breath-hold test is a noninvasive method of assessing CVR, yet there are no reliability data of this outcome in youth. This study aimed to assess the reliability of a breath-hold protocol to measure CVR in adolescents. METHODS Twenty-one 13 to 15 year old adolescents visited the laboratory on two separate occasions, to assess the within-test, within-day and between-day reliability of a breath-hold protocol, consisting of three breath-hold attempts. CVR was defined as the relative increase from baseline in middle cerebral artery mean blood velocity following a maximal breath-hold of up to 30 seconds, quantified via transcranial Doppler ultrasonography. RESULTS Mean breath-hold duration and CVR were never significantly correlated (r < .31, P > .08). The within-test coefficient of variation for CVR was 15.2%, with no significant differences across breath-holds (P = .88), so the three breath-hold attempts were averaged for subsequent analyses. The within- and between-day coefficients of variation for CVR were 10.8% and 15.3%, respectively. CONCLUSIONS CVR assessed via a three breath-hold protocol can be reliably measured in adolescents, yielding similar within- and between-day reliability. Analyses revealed that breath-hold length and CVR were unrelated, indicating the commonly reported normalization of CVR to breath-hold duration (breath-hold index) may be unnecessary in youth.
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Affiliation(s)
- Jodie L Koep
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- School of Human Movement and Nutrition Sciences, University of Queensland, Saint Lucia, Queensland, Australia
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Rhys Banks
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Rohit R Banger
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kate M Sansum
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Max E Weston
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- School of Human Movement and Nutrition Sciences, University of Queensland, Saint Lucia, Queensland, Australia
| | - Bert Bond
- Children's Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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13
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Chan ST, Evans KC, Song TY, Selb J, van der Kouwe A, Rosen BR, Zheng YP, Ahn A, Kwong KK. Cerebrovascular reactivity assessment with O2-CO2 exchange ratio under brief breath hold challenge. PLoS One 2020; 15:e0225915. [PMID: 32208415 PMCID: PMC7092994 DOI: 10.1371/journal.pone.0225915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypercapnia during breath holding is believed to be the dominant driver behind the modulation of cerebral blood flow (CBF). However, increasing evidence show that mild hypoxia and mild hypercapnia in breath hold (BH) could work synergistically to enhance CBF response. We hypothesized that breath-by-breath O2-CO2 exchange ratio (bER), defined as the ratio of the change in partial pressure of oxygen (ΔPO2) to that of carbon dioxide (ΔPCO2) between end inspiration and end expiration, would be able to better correlate with the global and regional cerebral hemodynamic responses (CHR) to BH challenge. We aimed to investigate whether bER is a more useful index than end-tidal PCO2 to characterize cerebrovascular reactivity (CVR) under BH challenge. METHODS We used transcranial Doppler ultrasound (TCD) to evaluate CHR under BH challenge by measuring cerebral blood flow velocity (CBFv) in the middle cerebral arteries. Regional changes in CHR to BH and exogenous CO2 challenges were mapped with blood oxygenation level dependent (BOLD) signal changes using functional magnetic resonance imaging (fMRI). We correlated respiratory gas exchange (RGE) metrics (bER, ΔPO2, ΔPCO2, end-tidal PCO2 and PO2, and time of breaths) with CHR (CBFv and BOLD) to BH challenge. Temporal features and frequency characteristics of RGE metrics and their coherence with CHR were examined. RESULTS CHR to brief BH epochs and free breathing were coupled with both ΔPO2 and ΔPCO2. We found that bER was superior to either ΔPO2 or ΔPCO2 alone in coupling with the changes of CBFv and BOLD signals under breath hold challenge. The regional CVR results derived by regressing BOLD signal changes on bER under BH challenge resembled those derived by regressing BOLD signal changes on end-tidal PCO2 under exogenous CO2 challenge. CONCLUSION Our findings provide a novel insight on the potential of using bER to better quantify CVR changes under BH challenge.
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Affiliation(s)
- Suk-tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Karleyton C. Evans
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Tian-yue Song
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Juliette Selb
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Andre van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Bruce R. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Yong-ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Andrew Ahn
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Kenneth K. Kwong
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
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14
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Webb AJS, Paolucci M, Mazzucco S, Li L, Rothwell PM. Confounding of Cerebral Blood Flow Velocity by Blood Pressure During Breath Holding or Hyperventilation in Transient Ischemic Attack or Stroke. Stroke 2019; 51:468-474. [PMID: 31884903 PMCID: PMC7004447 DOI: 10.1161/strokeaha.119.027829] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Breath holding (BH) and hyperventilation are used to assess abnormal cerebrovascular reactivity, often in relation to severity of small vessel disease and risk of stroke with carotid stenosis, but responses may be confounded by blood pressure (BP) changes. We compared effects of BP and end-tidal carbon dioxide (etCO2) on middle cerebral artery mean flow velocity (MFV) in consecutive transient ischemic attack and minor stroke patients. Methods- In the population-based, prospective OXVASC (Oxford Vascular Study) phenotyped cohort, change in MFV on transcranial Doppler ultrasound (ΔMFV, DWL-DopplerBox), beat-to-beat BP (Finometer), and etCO2 was measured during 30 seconds of BH or hyperventilation. Two blinded reviewers independently assessed recording quality. Dependence of ΔMFV on ΔBP and ΔetCO2 was determined by general linear models, stratified by quartiles. Results- Four hundred eighty-eight of 602 (81%) patients with adequate bone windows had high-quality recordings, more often in younger participants (64.6 versus 68.7 years; P<0.01), whereas 426 had hyperventilation tests (70.7%). During BH, ΔMFV was correlated with a rise in mean blood pressure (MBP; r2=0.15, P<0.001) but not ΔCO2 (r2=0.002, P=0.32), except in patients with ΔMBP <10% (r2=0.13, P<0.001). In contrast during hyperventilation, the fall in MFV was similarly correlated with reduction in CO2 and reduction in MBP (ΔCO2: r2=0.13, P<0.001; ΔMBP: r2=0.12, P<0.001), with a slightly greater effect of ΔCO2 when ΔMBP was <10% (r2=0.15). Stratifying by quartile, MFV increased linearly during BH across quartiles of ΔMBP, with no increase with ΔetCO2. In contrast, during hyperventilation, MFV decreased linearly with ΔetCO2, independent of ΔMBP. Conclusions- In older patients with recent transient ischemic attack or minor stroke, cerebral blood flow responses to BH were confounded by BP changes but reflected etCO2 change during hyperventilation. Correct interpretation of cerebrovascular reactivity responses to etCO2, including in small vessel disease and carotid stenosis, requires concurrent BP measurement.
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Affiliation(s)
- Alastair J S Webb
- From the Department of Clinical Neuroscience, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom (A.J.S.W., S.M., L.L., P.M.R.)
| | - Matteo Paolucci
- Headache and Neurosonology Unit, Neurology Department, Università Campus Bio-Medico, Rome, Italy (M.P.)
| | - Sara Mazzucco
- From the Department of Clinical Neuroscience, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom (A.J.S.W., S.M., L.L., P.M.R.)
| | - Linxin Li
- From the Department of Clinical Neuroscience, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom (A.J.S.W., S.M., L.L., P.M.R.)
| | - Peter M Rothwell
- From the Department of Clinical Neuroscience, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom (A.J.S.W., S.M., L.L., P.M.R.)
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15
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Hlavati M, Buljan K, Tomić S, Horvat M, Butković-Soldo S. Impaired cerebrovascular reactivity in chronic obstructive pulmonary disease. Acta Neurol Belg 2019; 119:567-575. [PMID: 31215005 DOI: 10.1007/s13760-019-01170-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022]
Abstract
Impaired cerebrovascular reactivity (CVR) is associated with stroke. Cerebrovascular diseases are common comorbidity in chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to quantify CVR in the anterior and posterior cerebral circulation during voluntary breath-holding in COPD patients according to airflow limitation severity. In this cross-sectional study, we compared 90 COPD patients without previous cerebrovascular disease and 30 age- and sex-matched healthy volunteers (mean age 67 ± 7.9, 87 males). Using transcranial Doppler ultrasound and breath-holding index (BHI), we analysed baseline mean flow velocities (MFV) and CVR of middle cerebral artery (MCA) and basilar artery (BA). Our results demonstrated that COPD patients had lower baseline MFV of both MCA and BA than controls. COPD patients had significantly lower BHImMCA and BHImBA than controls (0.8 and 0.7 versus 1.24 and 1.07, respectively; p < 0.001). With the severity of airflow obstruction, there were significant declines of BHImMCA and BHImBA in mild (0.94 and 0.83), moderate (0.8 and 0.7) and severe to very severe COPD (0.7 and 0.6), respectively (p < 0.001). For all participants, we found a significant and positive correlation between forced expiratory volume in one second (FEV1) and BHImMCA (Rho = 0.761, p < 0.001) and between FEV1 and BHImBA (Rho = 0.409, p < 0.001). COPD patients have impaired CVR in anterior and posterior cerebral circulation. Impairment of CVR increase with the airflow limitation severity. CVR is an appropriate marker to identify vulnerable COPD subjects at high risk to develop cerebrovascular disease. Prospective studies are needed for further evaluation.
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Affiliation(s)
- Marina Hlavati
- Department for Diagnostic and Therapeutical Procedures, Neurology Unit, General Hospital Našice, Bana Jelačića 10, 31500, Našice, Croatia.
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia.
| | - Krunoslav Buljan
- Neurology Clinic, Clinic Hospital Centre Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
| | - Svetlana Tomić
- Neurology Clinic, Clinic Hospital Centre Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
| | - Mirjana Horvat
- Department of Internal Medicine, Pulmonology Unit, General Hospital Našice, Bana Jelačića 10, 31500, Našice, Croatia
| | - Silva Butković-Soldo
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
- Neurology Clinic, Clinic Hospital Centre Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia
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16
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Steady-state cerebral blood flow regulation at altitude: interaction between oxygen and carbon dioxide. Eur J Appl Physiol 2019; 119:2529-2544. [DOI: 10.1007/s00421-019-04206-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/06/2019] [Indexed: 02/07/2023]
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17
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Friend AT, Balanos GM, Lucas SJ. Isolating the independent effects of hypoxia and hyperventilation‐induced hypocapnia on cerebral haemodynamics and cognitive function. Exp Physiol 2019; 104:1482-1493. [DOI: 10.1113/ep087602] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/25/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Alexander T. Friend
- School of SportExercise and Rehabilitation SciencesUniversity of Birmingham Edgbaston UK
| | - George M. Balanos
- School of SportExercise and Rehabilitation SciencesUniversity of Birmingham Edgbaston UK
| | - Samuel J.E. Lucas
- School of SportExercise and Rehabilitation SciencesUniversity of Birmingham Edgbaston UK
- Centre for Human Brain HealthUniversity of Birmingham Edgbaston UK
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18
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What Is the Point of the Peak? Assessing Steady-State Respiratory Chemoreflex Drive in High Altitude Field Studies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019. [PMID: 30357729 DOI: 10.1007/978-3-319-91137-3_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Measurements of central and peripheral respiratory chemoreflexes are important in the context of high altitude as indices of ventilatory acclimatization. However, respiratory chemoreflex tests have many caveats in the field, including considerations of safety, portability and consistency. This overview will (a) outline commonly utilized tests of the hypoxic ventilatory response (HVR) in humans, (b) outline the caveats associated with a variety of peak response HVR tests in the laboratory and in high altitude fieldwork contexts, and (c) advance a novel index of steady-state chemoreflex drive (SS-CD) that addresses the many limitations of other chemoreflex tests. The SS-CD takes into account the contribution of central and peripheral respiratory chemoreceptors, and eliminates the need for complex equipment and transient respiratory gas perturbation tests. To quantify the SS-CD, steady-state measurements of the pressure of end-tidal (PET)CO2 (Torr) and peripheral oxygen saturation (SpO2; %) are used to quantify a stimulus index (SI; PETCO2/SpO2). The SS-CD is then calculated by indexing resting ventilation (L/min) against the SI. SS-CD data are subsequently reported from 13 participants during incremental ascent to high altitude (5160 m) in the Nepal Himalaya. The mean SS-CD magnitude increased approximately 96% over 10 days of incremental exposure to hypobaric hypoxia, suggesting that the SS-CD tracks ventilatory acclimatization. This novel SS-CD may have future utility in fieldwork studies assessing ventilatory acclimatization during incremental or prolonged stays at altitude, and may replace the use of complex and potentially confounded transient peak response tests of the HVR in humans.
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Al-Khazraji BK, Shoemaker LN, Gati JS, Szekeres T, Shoemaker JK. Reactivity of larger intracranial arteries using 7 T MRI in young adults. J Cereb Blood Flow Metab 2019. [PMID: 29513623 PMCID: PMC6668520 DOI: 10.1177/0271678x18762880] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The larger intracranial conduit vessels contribute to the total cerebral vascular resistance, and understanding their vasoreactivity to physiological stimuli is required when attempting to understand regional brain perfusion. Reactivity of the larger cerebral conduit arteries remains understudied due to a need for improved imaging methods to simultaneously assess these vessels in a single stimulus. We characterized reactivity of basal intracranial conduit arteries (basilar, right and left posterior, middle and anterior cerebral arteries) and the right and left internal carotid arteries, to manipulations in end-tidal CO2 (PetCO2). Cross-sectional area changes (%CSA) were evaluated from high-resolution (0.5 mm isotropic) images collected at 7 T using a T1-weighted 3D SPACE pulse sequence, providing high contrast between vessel lumen and surrounding tissue. Cerebrovascular reactivity was calculated as %CSA/ΔPetCO2 in eight healthy individuals (18-23 years) during normocapnia (41 ± 4 mmHg), hypercapnia (48 ± 4 mmHg; breathing 5% CO2, balance oxygen), and hypocapnia (31 ± 8 mmHg; via hyperventilation). Reactivity to hypercapnia ranged from 0.8%/mmHg in the right internal carotid artery to 2.7%/mmHg in the left anterior cerebral artery. During hypocapnia, vasoconstriction ranged from 0.9%/mmHg in the basilar artery to 2.6%/mmHg in the right posterior cerebral artery. Heterogeneous cerebrovascular reactivity to hypercapnia and hypocapnia was characterized across basal intracranial conduit and internal carotid arteries.
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Affiliation(s)
- Baraa K Al-Khazraji
- 1 School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Leena N Shoemaker
- 1 School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Joseph S Gati
- 2 Robarts Research Institute, The University of Western Ontario, London, ON, Canada
| | - Trevor Szekeres
- 2 Robarts Research Institute, The University of Western Ontario, London, ON, Canada
| | - J Kevin Shoemaker
- 1 School of Kinesiology, The University of Western Ontario, London, ON, Canada.,3 Department of Physiology and Pharmacology, The University of Western Ontario, London, ON, Canada
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20
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Busch SA, Bruce CD, Skow RJ, Pfoh JR, Day TA, Davenport MH, Steinback CD. Mechanisms of sympathetic regulation during Apnea. Physiol Rep 2019; 7:e13991. [PMID: 30693670 PMCID: PMC6349657 DOI: 10.14814/phy2.13991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022] Open
Abstract
Volitional Apnea produces a robust peak sympathetic response through several interacting mechanisms. However, the specific contribution of each mechanism has not been elucidated. Muscle sympathetic activity was collected in participants (n = 10; 24 ± 3 years) that performed four maximal volitional apneas aimed at isolating lung-stretch (mechanical) and chemoreflex drive: (Ainslie and Duffin ) end-expiratory breath-hold, (Ainslie et al. ) end-inspiratory breath-hold, (Alpher et al. ) prehyperventilation breath-hold, and (Andersson and Schagatay ) prehyperoxia breath-hold. A final repeated rebreathe breath-hold protocol was performed to measure the peak sympathetic response during successive breath-holds at increasing chemoreflex stress. Finally, the influence of dynamic ventilation was assessed through asphyxic rebreathe. Muscle sympathetic activity was calculated as the change in burst frequency (burst/min), burst incidence (burst/100 heart-beats), and amplitude (au) between baseline and prevolitional breakpoint. Rebreathe was analyzed at similar chemoreflex stress as inspiratory breath-hold. All maneuvers increased muscle sympathetic activity compared to baseline (P < 0.01). However, prehyperoxia exhibited a smaller increase (+22.18 ± 9.13 burst/min; +25.52 ± 11.7 burst/100 heart-beats) compared to inspiratory, expiratory, and prehyperventilation breath-holds. At similar chemoreflex strain, rebreathe sympathetic activity was blunted compared to inspiratory breath-hold (P < 0.01). Finally, muscle sympathetic activity was not different between the repeated rebreathe trials, despite elevated chemoreflex stress and lower breath-hold duration with each subsequent breath-hold. We have demonstrated an obligatory role of the peripheral, but not central, chemoreflex (prehyperventilation vs. prehyperoxia) in producing peak sympathetic responses. At similar chemoreflex stresses the act of dynamic ventilation, but not static lung stretch per se, blunts muscle sympathetic activity. Finally, similar peak sympathetic responses during successive repeated breath-holds suggest a sympathetic ceiling may exist.
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Affiliation(s)
- Stephen A. Busch
- Neurovascular Health LaboratoryFaculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonAlbertaCanada
| | - Christina D. Bruce
- Department of BiologyFaculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Rachel J. Skow
- Neurovascular Health LaboratoryFaculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonAlbertaCanada
| | - Jaime R. Pfoh
- Department of BiologyFaculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Trevor A. Day
- Department of BiologyFaculty of Science and TechnologyMount Royal UniversityCalgaryAlbertaCanada
| | - Margie H. Davenport
- Neurovascular Health LaboratoryFaculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonAlbertaCanada
| | - Craig D. Steinback
- Neurovascular Health LaboratoryFaculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonAlbertaCanada
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21
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Keil VC, Eichhorn L, Mutsaerts HJMM, Träber F, Block W, Mädler B, van de Ven K, Siero JCW, MacIntosh BJ, Petr J, Fimmers R, Schild HH, Hattingen E. Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers. AJNR Am J Neuroradiol 2018; 39:1839-1847. [PMID: 30237299 DOI: 10.3174/ajnr.a5790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 07/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea. MATERIALS AND METHODS Fifteen male freedivers (age range, 20-64 years; cumulative previous prolonged breath-holds >2 minutes and 30 seconds: 4-79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and 31P-/1H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of >2 minutes and 30 seconds in a lifetime was assessed. RESULTS The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (-30.0%, P = .002), whereas CBF remained almost stable during this phase and increased in the late phase (+51.8%, P = .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 ± 14.2 versus posterior cerebral artery, 42.7 ± 10.8 mL/100 g/min; P = .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15-1.1 mL/100 g/min; P = .01). While breath-hold caused peripheral lactate rise (+18.5%) and hypoxemia (oxygen saturation, -24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [-6.4% phosphocreatine / (adenosine triphosphate + adenosine diphosphate); P = .02]. CONCLUSIONS This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response.
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Affiliation(s)
- V C Keil
- From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)
| | - L Eichhorn
- Anesthesiology and Intensive Care Medicine (L.E.)
| | - H J M M Mutsaerts
- Department of Radiology (H.J.M.M.M.), Academic Medical Center, Amsterdam, the Netherlands.,Sunnybrook Research Institute (H.J.M.M.M., B.J.M.), University of Toronto, Toronto, Ontario, Canada.,Department of Radiology (H.J.M.M.M., J.C.W.S.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Träber
- From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)
| | - W Block
- From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)
| | - B Mädler
- Philips GmbH (B.M), Bonn, Germany
| | - K van de Ven
- Philips Healthcare (K.v.d.V.), Best, the Netherlands
| | - J C W Siero
- Department of Radiology (H.J.M.M.M., J.C.W.S.), University Medical Center Utrecht, Utrecht, the Netherlands.,Spinoza Centre for Neuroimaging (J.C.W.S.), Amsterdam, the Netherlands
| | - B J MacIntosh
- Sunnybrook Research Institute (H.J.M.M.M., B.J.M.), University of Toronto, Toronto, Ontario, Canada
| | - J Petr
- Helmholtz Center Dresden-Rossendorf, Institute for Radiopharmaceutic Cancer Research (J.P.), PET Center, Dresden-Rossendorf, Germany
| | - R Fimmers
- Institut für Medizinische Biometrie, Informatik und Epidemiologie (R.F.), University Hospital Bonn, Bonn, Germany
| | - H H Schild
- From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)
| | - E Hattingen
- From the Departments of Radiology (V.C.K., F.T., W.B., H.H.S., E.H.)
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Zoghi A, Petramfar P, Nikseresht A, Sakhaee E. Investigation of ischemic and demyelinating lesions by cerebral vasoreactivity based on transcranial Doppler sonography: a comparative study. Neuropsychiatr Dis Treat 2018; 14:2323-2328. [PMID: 30254443 PMCID: PMC6141114 DOI: 10.2147/ndt.s150062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Variations of cerebral blood flow in response to hypoxia and hyperoxia in different disease conditions can provide new insights into disease etiopathogenesis. This study aimed to determine the characteristics of cerebral vasoreactivity for ischemia and demyelination. MATERIALS AND METHODS This case-control study included: 28 patients with lacunar infarctions verified by history, physical examination, and MRI; 28 age- and sex-matched healthy controls; 28 patients with relapsing-remitting multiple sclerosis (MS), based on McDonald criteria; and 28 age- and sex-matched healthy controls for the MS group. Transcranial Doppler sonography was undertaken in all subjects to calculate the mean flow velocity (MFV) of the right middle cerebral artery (MCA) and, after a breath-holding (BH) maneuver, the breath-holding index (BHI) was determined. RESULTS There was no significant difference of BHI and changes of MFV of the MCA in MS patients compared to controls (1.02 ± 0.4 vs 1.02 ± 0.3, p = 0.993; and 16.8 ± 8.1 vs 11.3 ± 10.8, p = 0.057). BHI in patients with lacunar infarctions was significantly lower (0.8 ± 0.4 vs 1.2 ± 0.3, p < 0.001) compared to controls. The BHI (p = 0.040) and variations of MFV of MCA (p = 0.007) in MS patients were significantly higher than in patients with lacunar infarctions. The vasoreactivity of demyelinating lesions was higher than that of ischemic ones. CONCLUSION Therefore, cerebral vasoreactivity determined by transcranial Doppler could be utilized for differentiating demyelinating from ischemic lesions.
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Affiliation(s)
- Anahita Zoghi
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Alireza Nikseresht
- Clinical Neurology Research Center, Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Ehsan Sakhaee
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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23
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Pfoh JR, Steinback CD, Vanden Berg ER, Bruce CD, Day TA. Assessing chemoreflexes and oxygenation in the context of acute hypoxia: Implications for field studies. Respir Physiol Neurobiol 2017; 246:67-75. [PMID: 28757365 DOI: 10.1016/j.resp.2017.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
Carotid chemoreceptors detect changes in PO2 and elicit a peripheral respiratory chemoreflex (PCR). The PCR can be tested through a transient hypoxic ventilatory response test (TT-HVR), which may not be safe nor feasible at altitude. We characterized a transient hyperoxic ventilatory withdrawal test in the setting of steady-state normobaric hypoxia (13.5-14% FIO2) and compared it to a TT-HVR and a steady-state poikilocapnic hypoxia test, within-individuals. No PCR test magnitude was correlated with any other test, nor was any test magnitude correlated with oxygenation while in steady-state hypoxia. Due to the heterogeneity between the different PCR test procedures and magnitudes, and the confounding effects of alterations in CO2 acting on both central and peripheral chemoreceptors, we developed a novel method to assess prevailing steady-state chemoreflex drive in the context of hypoxia. Quantifying peak hypoxic/hyperoxic responses at low altitude may have minimal utility in predicting oxygenation during ascent to altitude, and here we advance a novel index of chemoreflex drive.
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Affiliation(s)
- Jamie R Pfoh
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Craig D Steinback
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Emily R Vanden Berg
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Christina D Bruce
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada
| | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Canada; Department of Biology, Faculty of Science, University of Victoria, Canada.
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