Ultrasound Tissue Pulsatility Imaging Suggests Impairment in Global Brain Pulsatility and Small Vessels in Elderly Patients with Orthostatic Hypotension
Ultrasound Tissue Pulsatility Imaging Suggests Impairment in Global Brain Pulsatility and Small Vessels in Elderly Patients with Orthostatic Hypotension
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DOI：
10.1016/j.jstrokecerebrovasdis.2016.09.002
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发表时间：
2017-02-01
影响因子：
2.5
通讯作者：
Constans, Thierry
中科院分区：
文献类型：
--
作者：
Biogeau, Julie;Desmidt, Thomas;Constans, Thierry
背景资料：直立性低血压（OH）在老年人中非常普遍，这一人群可能会出现严重并发症，包括福尔斯和认知障碍，以及总体死亡率。然而，OH的病理生理学仍然知之甚少，需要脑血流量（CBF）评估的创新方法来准确地研究OH的脑血管反应性。目的：我们想比较80岁以上有和没有OH的老年患者在立位挑战期间脑组织搏动性（BTP）的变化。材料和方法：从法国图尔斯医院的老年科招募了42名80岁及以上的受试者，并根据立位挑战的结果将其分为两组。非纳入标准为任何与立位挑战不相容的一般不稳定的医学状况，没有颞叶声窗，严重认知障碍（简易精神状态检查< 15），中风史和法律的监护。我们使用了新颖的和高灵敏度的超声技术组织脉动成像测量BTP的变化，老年患者（n = 22）和无OH（n = 17）在直立挑战。结果如下：我们发现，平均脑组织脉动相关的全球颅内脉动，但不是最大脑组织脉动相关的大动脉脉动，显着降低OH患者，与外周血压的立即下降相比，延迟。结论：整体搏动性CBF变化和小血管搏动性，而不仅仅是大动脉的变化，可能是OH和脑血管疾病之间联系的关键机制。
Background: Orthostatic hypotension (OH) is highly prevalent in the elderly, and this population can be exposed to serious complications, including falls and cognitive disorders, as well as overall mortality. However, the pathophysiology of OH is still poorly understood, and innovative methods of cerebral blood flow (CBF) assessment have been required to accurately investigate cerebrovascular reactivity in OH. Objectives: We want to compare brain tissue pulsatility (BTP) changes during an orthostatic challenge in elderly patients over 80 with and without OH. Materials and Methods: Forty- two subjects aged 80 and over were recruited from the geriatric unit of the Hospital of Tours, France, and were divided into two groups according to the result of an orthostatic challenge. The noninclusion criteria were any general unstable medical condition incompatible with orthostatic challenge, having no temporal acoustic window, severe cognitive impairment (Mini Mental Status Examination < 15), history of stroke, and legal guardianship. We used the novel and highly sensitive ultrasound technique of tissue pulsatility imaging to measure BTP changes in elderly patients with (n = 22) and without OH (n = 17) during an orthostatic challenge. Results: We found that the mean brain tissue pulsatility related to global intracranial pulsatility, but not maximum brain tissue pulsatility related to large arteries pulsatility, decreased significantly in OH patients, with a delay compared with the immediate drop in peripheral blood pressure. Conclusion: Global pulsatile CBF changes and small vessels pulsatility, rather than changes in only large arteries, may be key mechanisms in OH to account for the links between OH and cerebrovascular disorders.