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Brain Sciences
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Cerebral Autoregulation and Cardiovascular Health
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Cerebral Autoregulation and Cardiovascular Health

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Molecular and Cellular Neuroscience".

Deadline for manuscript submissions: closed (25 January 2021) | Viewed by 28384

Special Issue Editors

Prof. Dr. Farzaneh Sorond

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Guest Editor
Department of Neurology, Northwestern University, Evanston, United States
Interests: cerebrobascular diseases; stroke; cerebral blood flow; cerebral autoregulation; cerebral vasoreactivity; neurovascular coupling; transcranial doppler; vascular cognitive impairment
Prof. Dr. Pedro Castro

E-Mail Website
Guest Editor
1. Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
2. Cardiovascular Research and Development Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
Interests: cerebrobascular diseases; stroke; cerebral blood flow; cerebral autoregulation; cerebral vasoreactivity; neurovascular coupling; transcranial doppler; cognitive impairment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cerebral autoregulation (CA) in various cerebrovascular conditions is a growing topic of interest. CA is the mechanism by which the cerebral vasculature maintains adequate flow in response to blood pressure oscillations. Along with cerebral vasoreactivity (VR) and neurovascular coupling (NVC), it helps the brain to preserve homeostasis and an exquisitely tuned performance. CA assessment is an important field of biomedical research and biosignal analysis. With the advent of proper tools like the transcranial Doppler ultrasound, we are now able to assess CA at the bedside. Recent technical and methodological advances have expanded these measures for use in neurocritical care units and acute cerebrovascular injuries. Disturbances in CA play a major role in both ischemic and haemorrhagic strokes as well as in responses to therapies. Recent studies provide strong evidence that CA indices could provide predictive measures for neurological outcomes in acute cerebrovascular injuries. Large multicentre efforts have been developed to produce standards to test and report CA and pave the way towards proof of concept trials. In addition to the central role for CA in acute cerebrovascular injuries, more recent studies also show that cerebrovascular dysregulation may contribute to cerebral small vessel disease-related cognitive impairment. Finally, CA may very likely be the mechanistic link in pathological conditions along the heart–brain axis.

In this Special Issue of Brain Sciences, we aim to present a collection of manuscripts on a variety of topics related to cerebral blood flow regulation in health and disease and bring together basic and clinical sciences to highlight the major achievements and future prospects in the field.

Prof. Dr. Farzaneh Sorond
Prof. Dr. Pedro Castro
Guest Editors

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Keywords

  • cerebral blood flow
  • autoregulation
  • cardiovascular disease
  • stroke
  • intracranial hemorrhages
  • small vessel disease
  • ultrasound

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Published Papers (8 papers)

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10 pages, 292 KiB  
Article
Neurovascular Coupling Impairment in Heart Failure with Reduction Ejection Fraction
by Ana Aires, António Andrade, Elsa Azevedo, Filipa Gomes, José Paulo Araújo and Pedro Castro
Brain Sci. 2020, 10(10), 714; https://doi.org/10.3390/brainsci10100714 - 7 Oct 2020
Cited by 9 | Viewed by 2388
Abstract
The hemodynamic consequences of a persistent reduced ejection fraction and unknown cardiac output on the brain have not been thoroughly studied. We sought to explore the status of the mechanisms of cerebrovascular regulation in patients with heart failure with reduced (HFrEF) and recovered [...] Read more.
The hemodynamic consequences of a persistent reduced ejection fraction and unknown cardiac output on the brain have not been thoroughly studied. We sought to explore the status of the mechanisms of cerebrovascular regulation in patients with heart failure with reduced (HFrEF) and recovered (HFrecEF) ejection fraction. We monitored cerebral blood flow velocity (CBFV) with transcranial Doppler and blood pressure. Cerebral autoregulation, assessed by transfer function from the spontaneous oscillations of blood pressure to CBFV and neurovascular coupling (NVC) with visual stimulation were compared between groups of HFrEF, HFrecEF and healthy controls. NVC was significantly impaired in HFrEF patients with reduced augmentation of CBFV during stimulation (overshoot systolic CBFV 19.11 ± 6.92 vs. 22.61 ± 7.78 vs. 27.92 ± 6.84, p = 0.04), slower upright of CBFV (rate time to overshoot: 1.19 ± 3.0 vs. 3.06 (4.30) vs. 2.90 ± 3.84, p = 0.02); p = 0.023) and reduced arterial oscillatory properties (natural frequency 0.17 ± 0.06 vs. 0.20 ± 0.09 vs. 0.24 ± 0.07, p = 0.03; attenuation 0.34 ± 0.24 vs. 0.48 ± 0.35 vs. 0.50 ± 0.23, p = 0.05). Cerebral autoregulation was preserved. The neurovascular unit of subjects with chronically reduced heart pumping capability is severely dysfunctional. Dynamic testing with transcranial Doppler could be useful in these patients, but whether it helps in predicting cognitive impairment must be addressed in future prospective studies. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
12 pages, 1415 KiB  
Article
The Effects of Hypocapnia on Brain Tissue Pulsations
by Meshal Alharbi, Poppy Turner, Jonathan Ince, Mitsuhiro Oura, Kelechi U. Ebirim, Alanoud Almudayni, Andrea Lecchini-Visintini, Jatinder S. Minhas and Emma M.L. Chung
Brain Sci. 2020, 10(9), 614; https://doi.org/10.3390/brainsci10090614 - 6 Sep 2020
Cited by 2 | Viewed by 3525
Abstract
Hypocapnia is known to affect patients with acute stroke and plays a key role in governing cerebral autoregulation. However, the impact of hypocapnia on brain tissue pulsations (BTPs) is relatively unexplored. As BTPs are hypothesised to result from cerebrovascular resistance to the inflow [...] Read more.
Hypocapnia is known to affect patients with acute stroke and plays a key role in governing cerebral autoregulation. However, the impact of hypocapnia on brain tissue pulsations (BTPs) is relatively unexplored. As BTPs are hypothesised to result from cerebrovascular resistance to the inflow of pulsatile arterial blood, it has also been hypothesised that cerebral autoregulation changes mediated by hypocapnia will alter BTP amplitude. This healthy volunteer study reports measurements of BTPs obtained using transcranial tissue Doppler (TCTD). Thirty participants underwent hyperventilation to induce mild hypocapnia. BTP amplitude, EtCO2, blood pressure, and heart rate were then analysed to explore the impact of hypocapnia on BTP amplitude. Significant changes in BTP amplitude were noted during recovery from hypocapnia, but not during the hyperventilation manoeuvre itself. However, a significant increase in heart rate and pulse pressure and decrease in mean arterial pressure were also observed to accompany hypocapnia, which may have confounded our findings. Whilst further investigation is required, the results of this study provide a starting point for better understanding of the effects of carbon dioxide levels on BTPs. Further research in this area is needed to identify the major physiological drivers of BTPs and quantify their interactions with other aspects of cerebral haemodynamics. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
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17 pages, 805 KiB  
Article
The Effects of Gradual Change in Head Positioning on the Relationship between Systemic and Cerebral Haemodynamic Parameters in Healthy Controls and Acute Ischaemic Stroke Patients
by Eloise Sands, Louvinia Wong, Man Y. Lam, Ronney B. Panerai, Thompson G. Robinson and Jatinder S. Minhas
Brain Sci. 2020, 10(9), 582; https://doi.org/10.3390/brainsci10090582 - 22 Aug 2020
Cited by 6 | Viewed by 4028
Abstract
(1) Background: Larger blood pressure variability (BPv) in the first 3 h post-stroke onset increases pathophysiological effects such as infarct size, and leads to greater risk of disability, comorbidities and mortality at 90 days. However, there is limited information on the relationship between [...] Read more.
(1) Background: Larger blood pressure variability (BPv) in the first 3 h post-stroke onset increases pathophysiological effects such as infarct size, and leads to greater risk of disability, comorbidities and mortality at 90 days. However, there is limited information on the relationship between systemic and cerebral haemodynamic and variability parameters. (2) Objectives: This study determined the effect of a gradual change in head position (GHP) on cerebral blood flow velocity variability (CBFVv) and mean arterial blood pressure variability (MABPv), in healthy controls and acute ischaemic stroke (AIS) patients. Methods: CBFVv and MABPv were expressed as standard deviation (SD) and coefficient of variation. A total of 16 healthy controls (mean age 57 ± 16 years) were assessed over two visits, 12 ± 8 days apart, and 15 AIS patients (mean age 69 ± 8.5 years) were assessed over three visits (V1: 13.3 ± 6.9 h, V2: 4.9 ± 3.2 days and V3: 93.9 ± 11.5 days post-stroke). (3) Results: In response to GHP, MABPv does not initially increase, but over time MABPv showed a significant increase in response to GHP in AIS (visits 2 and 3) and controls (visit 2). Additionally, in response to GHP in AIS, CBFVv increased in the affected hemisphere. Lastly, in AIS, a significant correlation between CBFVv and MABPv, assessed by SD, was seen in the unaffected hemisphere, whereas this relationship was not demonstrated in the affected hemisphere. (4) Conclusions: To our knowledge, this is the first study to analyse the relationship between CBFVv and MABPv. Shedding light on the effect of head position on the relationship between cerebral blood flow and blood pressure is important to improve our understanding of the underlying effects of cerebral autoregulation impairment. This early mechanistic study provides evidence supporting supine head positioning in healthy controls and stroke patients, through demonstration of a reduction of MABPv and increase in CBFVv. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
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11 pages, 293 KiB  
Communication
Cerebral Hemodynamic Changes to Transcranial Doppler in Asymptomatic Patients with Fabry’s Disease
by Carla Vagli, Francesco Fisicaro, Luisa Vinciguerra, Valentina Puglisi, Margherita Stefania Rodolico, Antonello Giordano, Raffaele Ferri, Giuseppe Lanza and Rita Bella
Brain Sci. 2020, 10(8), 546; https://doi.org/10.3390/brainsci10080546 - 12 Aug 2020
Cited by 24 | Viewed by 3378
Abstract
Background: Patients with Fabry’s disease (FD) may be asymptomatic or show a spectrum of clinical manifestations, including cerebrovascular disease, mainly affecting posterior circulation. Few and conflicting studies on cerebral blood flow (CBF) velocity by transcranial Doppler sonography (TCD) in asymptomatic FD (aFD) subjects [...] Read more.
Background: Patients with Fabry’s disease (FD) may be asymptomatic or show a spectrum of clinical manifestations, including cerebrovascular disease, mainly affecting posterior circulation. Few and conflicting studies on cerebral blood flow (CBF) velocity by transcranial Doppler sonography (TCD) in asymptomatic FD (aFD) subjects have been published. Our study aims to assess TCD in aFD subjects to identify any preclinical CBF change. Methods: A total of 30 aFD subjects were consecutively recruited and compared to 28 healthy controls. Brain magnetic resonance imaging was normal in all participants. TCD was used to study blood flow velocity and indices of resistance of intracranial arteries from the middle cerebral artery (MCA), bilaterally, and from the basilar artery (BA). Cerebral vasomotor reactivity (CVR) was also evaluated from MCA. Results: No difference was found between groups for MCA parameters of CBF velocity and CVR. Compared to controls, a higher mean blood flow velocity and a lower resistance index from BA were observed in FD subjects. No correlation was found between any BA-derived TCD parameter and the level of lyso-globotriaosylceramide. Conclusions: aFD subjects show evidence of altered CBF velocity in posterior circulation. Preclinical detection of neurovascular involvement in FD might allow appropriate management and prevention of future cerebrovascular complications and disability. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
9 pages, 573 KiB  
Article
Evaluation of Cerebral Microvascular Regulatory Mechanisms with Transcranial Doppler in Fabry Disease
by Pedro Castro, Mariana Gutierres, Gilberto Pereira, Susana Ferreira, João Paulo Oliveira and Elsa Azevedo
Brain Sci. 2020, 10(8), 528; https://doi.org/10.3390/brainsci10080528 - 7 Aug 2020
Cited by 7 | Viewed by 2808
Abstract
Background: Fabry disease (FD) causes cerebrovascular disease (CVD) even if asymptomatic, and this is why it is important to identify non-invasive methods to monitor the disease. We evaluated the usefulness of the cerebral autoregulation, vasoreactivity, and neurovascular coupling assessed by transcranial Doppler (TCD) [...] Read more.
Background: Fabry disease (FD) causes cerebrovascular disease (CVD) even if asymptomatic, and this is why it is important to identify non-invasive methods to monitor the disease. We evaluated the usefulness of the cerebral autoregulation, vasoreactivity, and neurovascular coupling assessed by transcranial Doppler (TCD) in FD. Methods: Ten adult patients with classic phenotype FD, without clinical expression of CVD, and ten healthy controls, were included. We monitored cerebral blood flow velocity with TCD in the middle and posterior cerebral arteries, blood pressure, heart rate, and non-invasive expired carbon dioxide (CO2). Cerebral autoregulation was calculated from the spontaneous oscillations of blood pressure, cerebral vasoreactivity through CO2 inhalation and hyperventilation and neurovascular coupling by the flow velocity change to visual stimulation. Results: FD male patients showed blunted vasoreactivity in posterior circulation (0.70 ± 0.36%/mmHg vs. 1.09 ± 0.18%/mmHg CO2, p = 0.01) and impaired neurovascular coupling (overshoot 15 ± 2.9% vs. 28 ± 6.1%, p < 0.01). Cerebral autoregulation was similar to controls. Conclusion: Male patients with FD classic phenotype and hitherto clinical expression of CVD already show impairment of cerebral vasoreactivity and neurovascular coupling. It supports the notion of an early dysfunction of cerebral microvascular in a presymptomatic stage of CVD in FD and that TCD could be useful in its assessment. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
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12 pages, 3128 KiB  
Article
Comparative Study of Novel Noninvasive Cerebral Autoregulation Volumetric Reactivity Indices Reflected by Ultrasonic Speed and Attenuation as Dynamic Measurements in the Human Brain
by Basant K. Bajpai, Rolandas Zakelis, Mantas Deimantavicius and Daiva Imbrasiene
Brain Sci. 2020, 10(4), 205; https://doi.org/10.3390/brainsci10040205 - 1 Apr 2020
Viewed by 2578
Abstract
This is a comparative study of two novel noninvasive cerebrovascular autoregulation (CA) monitoring methods based on intracranial blood volume (IBV) changes in the human brain. We investigated the clinical applicability of the new volumetric reactivity index (VRx2), reflected by intracranial ultrasonic attenuation dynamics [...] Read more.
This is a comparative study of two novel noninvasive cerebrovascular autoregulation (CA) monitoring methods based on intracranial blood volume (IBV) changes in the human brain. We investigated the clinical applicability of the new volumetric reactivity index (VRx2), reflected by intracranial ultrasonic attenuation dynamics for noninvasive CA monitoring. The CA was determined noninvasively on 43 healthy participants by calculating the volumetric reactivity index (VRx1 from time-of-flight of ultrasound, VRx2 from attenuation of ultrasound). The VRx was calculated as a moving correlation coefficient between the arterial blood pressure and noninvasively measured IBV slow waves. Linear regression between VRx1 and VRx2 (averaged per participants) showed a significant correlation (r = 0.731, p < 0.0001, 95% confidence interval [0.501–0.895]) in data filtered by bandpass filtering. On the other hand, FIR filtering demonstrated a slightly better correlation (r = 0.769, p < 0.0001, 95% confidence interval [0.611–0.909]). The standard deviation of the difference by bandpass filtering was 0.1647 and bias −0.3444; and by FIR filtering 0.1382 and bias −0.3669. This comparative study showed a significant coincidence of the VRx2 index compared to that of VRx1. Hence, VRx2 could be used as an alternative, cost-effective noninvasive cerebrovascular autoregulation index in the same way as VRx1 values are used. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
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Review

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19 pages, 7558 KiB  
Review
Cerebral Autoregulation in Ischemic Stroke: From Pathophysiology to Clinical Concepts
by Ricardo C. Nogueira, Lucy Beishon, Edson Bor-Seng-Shu, Ronney B. Panerai and Thompson G. Robinson
Brain Sci. 2021, 11(4), 511; https://doi.org/10.3390/brainsci11040511 - 16 Apr 2021
Cited by 17 | Viewed by 5660
Abstract
Ischemic stroke (IS) is one of the most impacting diseases in the world. In the last decades, new therapies have been introduced to improve outcomes after IS, most of them aiming for recanalization of the occluded vessel. However, despite this advance, there are [...] Read more.
Ischemic stroke (IS) is one of the most impacting diseases in the world. In the last decades, new therapies have been introduced to improve outcomes after IS, most of them aiming for recanalization of the occluded vessel. However, despite this advance, there are still a large number of patients that remain disabled. One interesting possible therapeutic approach would be interventions guided by cerebral hemodynamic parameters such as dynamic cerebral autoregulation (dCA). Supportive hemodynamic therapies aiming to optimize perfusion in the ischemic area could protect the brain and may even extend the therapeutic window for reperfusion therapies. However, the knowledge of how to implement these therapies in the complex pathophysiology of brain ischemia is challenging and still not fully understood. This comprehensive review will focus on the state of the art in this promising area with emphasis on the following aspects: (1) pathophysiology of CA in the ischemic process; (2) methodology used to evaluate CA in IS; (3) CA studies in IS patients; (4) potential non-reperfusion therapies for IS patients based on the CA concept; and (5) the impact of common IS-associated comorbidities and phenotype on CA status. The review also points to the gaps existing in the current research to be further explored in future trials. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
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Other

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13 pages, 1112 KiB  
Brief Report
Dynamic Cerebral Autoregulation Post Endovascular Thrombectomy in Acute Ischemic Stroke
by Faheem Sheriff, Pedro Castro, Mariel Kozberg, Sarah LaRose, Andrew Monk, Elsa Azevedo, Karen Li, Sameen Jafari, Shyam Rao, Fadar Oliver Otite, Ayaz Khawaja, Farzaneh Sorond, Steven Feske, Can Ozan Tan and Henrikas Vaitkevicius
Brain Sci. 2020, 10(9), 641; https://doi.org/10.3390/brainsci10090641 - 16 Sep 2020
Cited by 23 | Viewed by 3272
Abstract
The development of the endovascular thrombectomy (EVT) technique has revolutionized acute stroke management for patients with large vessel occlusions (LVOs). The impact of successful recanalization using an EVT on autoregulatory profiles is unknown. A more complete understanding of cerebral autoregulation in the context [...] Read more.
The development of the endovascular thrombectomy (EVT) technique has revolutionized acute stroke management for patients with large vessel occlusions (LVOs). The impact of successful recanalization using an EVT on autoregulatory profiles is unknown. A more complete understanding of cerebral autoregulation in the context of EVT may assist with post-procedure hemodynamic optimization to prevent complications. We examined cerebral autoregulation in 107 patients with an LVO in the anterior circulation (proximal middle cerebral artery (M1/2) and internal cerebral artery (ICA) terminus) who had been treated using an EVT. Dynamic cerebral autoregulation was assessed at multiple time points, ranging from less than 24 hours to 5 days following last seen well (LSW) time, using transcranial Doppler ultrasound recordings and transfer function analysis. Complete (Thrombolysis in Cerebral Infarction (TICI) 3) recanalization was associated with a more favorable autoregulation profile compared with TICI 2b or poorer recanalization (p < 0.05), which is an effect that was present after accounting for differences in the infarct volumes. Less effective autoregulation in the first 24 h following the LSW time was associated with increased rates of parenchymal hematoma types 1 and 2 hemorrhagic transformations (PH1–PH2). These data suggest that patients with incomplete recanalization and poor autoregulation (especially within the first 24 h post-LSW time) may warrant closer blood pressure monitoring and control in the first few days post ictus. Full article
(This article belongs to the Special Issue Cerebral Autoregulation and Cardiovascular Health)
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