Impaired dynamic cerebral autoregulation measured in the middle cerebral artery in patients with vertebrobasilar ischemia is associated with autonomic failure.
Impaired dynamic cerebral autoregulation measured in the middle cerebral artery in patients with vertebrobasilar ischemia is associated with autonomic failure.
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DOI：
10.1016/j.jstrokecerebrovasdis.2023.107454
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发表时间：
2023-11-04
影响因子：
2.5
通讯作者：
Bolognese，Manuel
中科院分区：
文献类型：
--
作者：
Lakatos，Lehel Barna;Shin，Dae C.;Bolognese，Manuel
目的探讨椎基底动脉缺血（VBI）对脑皮质血流（CBF）调节的影响。（平均年龄65 ± 15岁; 21例VBI患者接受了结构化卒中护理，通过使用血压（BP）自发振荡的传递函数分析评估了双侧大脑中动脉（MCA）的动态脑自动调节（dCA）以及通过提取非常低（0.02-0.07 Hz）、低（0.07-0.15 Hz）和高频率（0.15-0.5 Hz）范围内的相位和增益信息而产生的CBF速度。此外，对血压和心率变异性（HRV）进行功率谱分析。对照组由29个年龄和性别匹配的健康persons.ResultsCompared对照组，在VBI患者的相位显着减少和增益增加的非常低的频率（VLF），在低（LF），相位显着减少，只有同侧。在高频率（HF），相位减少只是轻微的显着。血压功率谱密度（PSD）在所有频率的患者比对照组高得多。在心率变异性的PSD中，对照组而非患者在0.11Hz附近表现出强峰，而患者在0.36Hz附近表现出强峰，而非对照组。在回归分析中，患者的相位和增益结果与年龄、性别、动脉高血压、糖尿病、肾功能不全、左心室射血分数所指示的心力衰竭、卒中亚型、是否存在脑小血管疾病无关。disbalance.ClinicalTrials.gov
ObjectivesTo assess whether vertebrobasilar artery ischemia (VBI) affects cortical cerebral blood flow (CBF) regulation.Material and Methods107 consecutive patients (mean age 65 ± 15 years; women 21) with VBI underwent structured stroke care with assessment of dynamic cerebral autoregulation (dCA) in both middle cerebral arteries (MCAs) by transfer function analysis using spontaneous oscillations of blood pressure (BP) and CBF velocity that yields by extraction of phase and gain information in the very low (0.02-0.07 Hz), low (0.07-0.15 Hz) and high frequency (0.15-0.5 Hz) ranges. Additionally, power spectrum analysis of BP and heart rate variability (HRV) was performed. The control group consists of 29 age- and sex-matched healthy persons.ResultsCompared to controls, phase in the VBI patients was significantly reduced and gain increased in the very low frequencies (VLF), in the low (LF), phase was significantly reduced only ipsilaterally. In the high frequencies (HF), phase reduction was only marginally significant. BP power spectral density (PSD) was much higher in the patients than in the controls across all frequencies. In the PSD of heart rate variability the controls but not the patients exhibited a strong peak around 0.11Hz, while the patients, but not the controls, exhibit a strong peak around 0.36 Hz. In regression analysis, patient's phase and gain results were not related to age, sex, arterial hypertension, diabetes mellitus, renal dysfunction, heart failure as indicated by left ventricular ejection fraction, stroke subtype, presence or absence of cerebral small vessel disease.ConclusionPatients with VBI exhibit bilateral cortical autoregulation impairment in association with an autonomic nervous system disbalance.ClinicalTrials.gov IdentifierNCT04611672