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Abadjiev DS, Toschi-Dias E, Salinet ASM, Gaykova NN, Lo MT, Nogueira RC, Hu K. Daily rhythm of dynamic cerebral autoregulation in patients after stroke. J Cereb Blood Flow Metab 2023; 43:989-998. [PMID: 36722135 PMCID: PMC10196745 DOI: 10.1177/0271678x231153750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/02/2022] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Abstract
Dynamic cerebral autoregulation (dCA) in healthy young adults displays a daily variation. Whether the rhythm exists in patients with stroke is unknown. We studied 28 stroke patients (age: 26-83 years, 7 females) within 48 hours after thrombolysis. dCA was assessed 54 times in these patients during supine rest (twice in 26 and once in 2 patients): 9 assessments between 0-9AM, 12 between 9AM-2PM, 20 between 2-7PM, and 13 between 7PM-12AM. To estimate dCA, phase shifts between spontaneous oscillations of cerebral blood flow velocity (CBFV) in the middle cerebral artery and arterial blood pressure (BP) were obtained in four frequency bands: <0.05 Hz, 0.05-0.1 Hz, 0.1-0.2 Hz, and >0.2 Hz. CBFV-BP phase shifts at <0.05 Hz were significantly larger between 2-7PM, suggesting better dCA, than those at other times (p < 0.0001), and the daily rhythm was consistent for stroke and non-stroke sides. No significant rhythms were observed at higher frequencies (all p > 0.2). All results were independent of age, sex, stroke type and severity, and other cardiovascular conditions. dCA after stroke showed a daily rhythm, leading to a better regulation of CBFV at <0.05 Hz during the afternoon. The finding may have implications for daily activity management of stroke patients.
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Affiliation(s)
- Daniel S Abadjiev
- Medical Biodynamics Program,
Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Edgar Toschi-Dias
- Neurology Department, School of
Medicine, Hospital das Clinicas, University of São Paulo, São Paulo ,
Brazil
| | - Angela SM Salinet
- Neurology Department, School of
Medicine, Hospital das Clinicas, University of São Paulo, São Paulo ,
Brazil
| | - Nicole N Gaykova
- Medical Biodynamics Program,
Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Men-Tzung Lo
- Institute of Translational and
Interdisciplinary Medicine and Department of Biomedical Sciences and
Engineering, National Central University, Taoyuan
| | - Ricardo C Nogueira
- Neurology Department, School of
Medicine, Hospital das Clinicas, University of São Paulo, São Paulo ,
Brazil
- Neurology Department, Hospital
Sirio Libanes, São Paulo, Brazil
| | - Kun Hu
- Medical Biodynamics Program,
Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
- Division of Sleep Medicine, Harvard
Medical School, Boston, MA, USA
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Worley ML, Reed EL, Chapman CL, Kueck P, Seymour L, Fitts T, Zazulak H, Schlader ZJ, Johnson BD. Acute beetroot juice consumption does not alter cerebral autoregulation or cardiovagal baroreflex sensitivity during lower-body negative pressure in healthy adults. Front Hum Neurosci 2023; 17:1115355. [PMID: 36742355 PMCID: PMC9892911 DOI: 10.3389/fnhum.2023.1115355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Beetroot juice (BRJ) improves peripheral endothelial function and vascular compliance, likely due to increased nitric oxide bioavailability. It is unknown if BRJ alters cerebrovascular function and cardiovagal baroreflex control in healthy individuals. Purpose We tested the hypotheses that BRJ consumption improves cerebral autoregulation (CA) and cardiovagal baroreflex sensitivity (cBRS) during lower-body negative pressure (LBNP). Methods Thirteen healthy adults (age: 26 ± 4 years; 5 women) performed oscillatory (O-LBNP) and static LBNP (S-LBNP) before (PRE) and 3 h after consuming 500 mL of BRJ (POST). Participants inhaled 3% CO2 (21% O2, 76% N2) during a 5 min baseline and throughout LBNP to attenuate reductions in end-tidal CO2 tension (PETCO2). O-LBNP was conducted at ∼0.02 Hz for six cycles (-70 mmHg), followed by a 3-min recovery before S-LBNP (-40 mmHg) for 7 min. Beat-to-beat middle cerebral artery blood velocity (MCAv) (transcranial Doppler) and blood pressure were continuously recorded. CA was assessed using transfer function analysis to calculate coherence, gain, and phase in the very-low-frequency (VLF; 0.020-0.070 Hz) and low-frequency bands (LF; 0.07-0.20 Hz). cBRS was calculated using the sequence method. Comparisons between POST vs. PRE are reported as mean ± SD. Results During O-LBNP, coherence VLF was greater at POST (0.55 ± 0.06 vs. 0.46 ± 0.08; P < 0.01), but phase VLF (P = 0.17) and gain VLF (P = 0.69) were not different. Coherence LF and phase LF were not different, but gain LF was lower at POST (1.03 ± 0.20 vs. 1.12 ± 0.30 cm/s/mmHg; P = 0.05). During S-LBNP, CA was not different in the VLF or LF bands (all P > 0.10). Up-cBRS and Down-cBRS were not different during both LBNP protocols. Conclusion These preliminary data indicate that CA and cBRS during LBNP in healthy, young adults is largely unaffected by an acute bolus of BRJ.
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Affiliation(s)
- Morgan L. Worley
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Emma L. Reed
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Department of Human Physiology, Bowerman Sports Science Center, University of Oregon, Eugene, OR, United States
| | - Christopher L. Chapman
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Department of Human Physiology, Bowerman Sports Science Center, University of Oregon, Eugene, OR, United States
| | - Paul Kueck
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Lauren Seymour
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Triniti Fitts
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Hannah Zazulak
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Zachary J. Schlader
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Blair D. Johnson
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
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Panerai RB, Brassard P, Burma JS, Castro P, Claassen JA, van Lieshout JJ, Liu J, Lucas SJ, Minhas JS, Mitsis GD, Nogueira RC, Ogoh S, Payne SJ, Rickards CA, Robertson AD, Rodrigues GD, Smirl JD, Simpson DM. Transfer function analysis of dynamic cerebral autoregulation: A CARNet white paper 2022 update. J Cereb Blood Flow Metab 2023; 43:3-25. [PMID: 35962478 PMCID: PMC9875346 DOI: 10.1177/0271678x221119760] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cerebral autoregulation (CA) refers to the control of cerebral tissue blood flow (CBF) in response to changes in perfusion pressure. Due to the challenges of measuring intracranial pressure, CA is often described as the relationship between mean arterial pressure (MAP) and CBF. Dynamic CA (dCA) can be assessed using multiple techniques, with transfer function analysis (TFA) being the most common. A 2016 white paper by members of an international Cerebrovascular Research Network (CARNet) that is focused on CA strove to improve TFA standardization by way of introducing data acquisition, analysis, and reporting guidelines. Since then, additional evidence has allowed for the improvement and refinement of the original recommendations, as well as for the inclusion of new guidelines to reflect recent advances in the field. This second edition of the white paper contains more robust, evidence-based recommendations, which have been expanded to address current streams of inquiry, including optimizing MAP variability, acquiring CBF estimates from alternative methods, estimating alternative dCA metrics, and incorporating dCA quantification into clinical trials. Implementation of these new and revised recommendations is important to improve the reliability and reproducibility of dCA studies, and to facilitate inter-institutional collaboration and the comparison of results between studies.
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Affiliation(s)
- Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester and NIHR Biomedical Research Centre, Leicester, UK
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, and Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Pedro Castro
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jurgen Ahr Claassen
- Department of Geriatric Medicine and Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Johannes J van Lieshout
- Department of Internal Medicine, Amsterdam, UMC, The Netherlands and Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, UK
| | - Jia Liu
- Institute of Advanced Computing and Digital Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen University Town, Shenzhen, China
| | - Samuel Je Lucas
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester and NIHR Biomedical Research Centre, Leicester, UK
| | - Georgios D Mitsis
- Department of Bioengineering, McGill University, Montreal, Québec, QC, Canada
| | - Ricardo C Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei
| | - Caroline A Rickards
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Andrew D Robertson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Gabriel D Rodrigues
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jonathan D Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David M Simpson
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
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Tian G, Ji Z, Lin Z, Pan S, Yin J. Cerebral autoregulation is heterogeneous in different stroke mechanism of ischemic stroke caused by intracranial atherosclerotic stenosis. Brain Behav 2021; 11:e01907. [PMID: 33095506 PMCID: PMC7821627 DOI: 10.1002/brb3.1907] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic stenosis (ICAS) is the most common cause of ischemic stroke (IS) and is associated with stroke recurrence. It results in IS due to a variety of mechanisms. However, the influence of brain reserve mechanism on different stroke mechanism is still unclear. Cerebral autoregulation (CA) is an important brain reserve mechanism and is impaired after IS. This study aimed to explore the impaired pattern of CA and assess the association between CA and stroke risk factors in different stroke mechanism caused by ICAS. METHODS IS patients with ICAS (50%-99% stenosis/occlusion) in middle cerebral artery (MCA) or internal carotid artery were enrolled to receive CA examinations within 7 days after onset. Healthy volunteers were also recruited as controls. CA was recorded from spontaneous fluctuations of blood pressure and MCA flow velocity. Transfer function analysis was used to derive CA parameters, including phase difference (PD) and coherence in the low-frequency range (0.06-0.12 Hz). RESULTS A total of 89 IS patients and 90 healthy controls were included. Compared with controls, CA was impaired ipsilaterally in patients with parent artery atherosclerosis occluding penetrating artery (POPA) while CA was bilaterally impaired in other stroke mechanisms. And CA on ipsilateral hemisphere was correlated with hypertension/hyperlipidemia in patients with POPA (r = -0.481, p = .008; r = -0.484, p = .008). While CA on ipsilateral hemisphere was correlated with perfusion parameter including the arterial spin-labeling (ASL) parameter cerebral blood flow (CBF) (r = 0.893, p = .007) and collateral circulation status the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) (r = 0.610, p = .021) in patients with hypoperfusion mechanism. CONCLUSION In IS patients, CA was impaired heterogeneously and was correlated with different risk factors in varied stroke mechanism. CA can be as an informative determinant of stroke risk in patients with ICAS and to help improving individualized treatment strategies in the presence of ischemic stroke caused by ICAS.
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Affiliation(s)
- Ge Tian
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhong Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenzhou Lin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Yin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Minvaleev RS, Bogdanov RR, Bahner DP, Levitov AB. Headstand (Sirshasana) Does Not Increase the Blood Flow to the Brain. J Altern Complement Med 2019; 25:827-832. [PMID: 31219304 DOI: 10.1089/acm.2019.0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Most yoga practitioners believe that headstand (Sirshasana) results in increased cerebral perfusion. This, however, is not consistent with autoregulation of the cerebral blood flow. The intent of this study was to demonstrate the effect of Sirshasana on the blood flow to the brain through ultrasound examination of the internal carotid artery (ICA). Design, location, and subjects: The ICA blood flow was measured with pulsed Doppler in 20 men and women aged 10 to 59 years (median 43) while performing the headstand (Sirshasana). Seventeen subjects were studied in 2018 in Spain at the altitude of 2,000 m, whereas the other three females were studied at sea level. Results: Although the diameter of the artery under examination during the headstand remained almost unchanged, the decrease in peak flow velocities in systole and diastole caused a significant decrease in arterial blood flow to the brain, followed by return to baseline values immediately after the antiorthostatic postural effect, likely due to the expected consequences of the cerebral blood flow autoregulation of the cerebral blood supply as well as the intracranial pressure. Conclusions: Contrary to popular belief, Sirshasana does not increase blood flow to the brain through the ICA, but results in predictable reduction in cerebral blood delivery in compliance with known mechanisms of autoregulation of cerebral blood flow. Moreover, increased ICA blood flow while performing the headstand is likely to be a contraindication to this exercise.
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Affiliation(s)
| | | | - David P Bahner
- 3The Ohio State University Wexner Medical Centre, Columbus, Ohio
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