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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 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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Kogelschatz B, Zenger B, Steinberg BA, Ranjan R, Jared Bunch T. Atrial fibrillation and the risk of early-onset dementia and cognitive decline: An updated review. Trends Cardiovasc Med 2024; 34:236-241. [PMID: 36702389 DOI: 10.1016/j.tcm.2023.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
The relationship between atrial fibrillation (AF) and dementia has been well described; however, recent data suggest that AF confers a greater risk for the development of early-onset dementia irrespective of clinical stroke. Numerous mechanisms have been hypothesized to explain cognitive decline in the setting of AF, including silent cerebral ischemia, cerebral hypoperfusion, and cerebral microvascular disease. Despite the emergence of data supporting the increased risk of early-onset dementia in patients with AF, the underlying mechanism remains unclear. Furthermore, the mechanism may be influenced by survival bias, genetic susceptibility, or early dysfunction of brain adaptation. Investigation into why this relationship exists could change how prevention and treatment are evaluated.
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Affiliation(s)
- Benjamin Kogelschatz
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Brian Zenger
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA.
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Sprick JD, Sabino‐Carvalho J, Mekonnen E, McGranahan M, Zanuzzi M, DaCosta D, Park J. Cerebrovascular carbon dioxide reactivity is intact in chronic kidney disease. Physiol Rep 2024; 12:e15998. [PMID: 38570312 PMCID: PMC10990926 DOI: 10.14814/phy2.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
Chronic kidney disease (CKD) is characterized by an elevated risk for cerebrovascular disease including stroke. One mechanism that may contribute to this heightened risk is an impairment in cerebrovascular carbon dioxide reactivity (CVR). We compared CVR between CKD patients stages III-IV and controls (CON) without CKD but matched for hypertension and diabetes status. CVR was measured via 5% CO2 inhalation followed by voluntary hyperventilation in 14 CKD and 11 CON participants while mean arterial pressure, end-tidal carbon dioxide, and middle cerebral artery blood velocity (MCAv) were measured continuously. CVR was quantified as the linear relationship between etCO2 and MCAv. We observed no difference in CVR between groups. Hypercapnic CVR: CKD = 1.2 ± 0.9 cm/s/mm Hg, CON = 1.3 ± 0.8 cm/s/mm Hg, hypocapnic CVR: CKD = 1.3 ± 0.9 cm/s/mm Hg, CON = 1.5 ± 0.7 cm/s/mm Hg, integrated CVR: CKD = 1.5 ± 1.1 cm/s/mm Hg, CON = 1.7 ± 0.8 cm/s/mm Hg, p ≥ 0.48. Unexpectedly, CVR was inversely related to estimated glomerular filtration rate in CKD (R2 = 0.37, p = 0.02). We report that CVR remains intact in CKD and is inversely related to eGFR. These findings suggest that other mechanisms beyond CVR contribute to the elevated stroke risk observed in CKD.
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Affiliation(s)
- Justin D. Sprick
- Department of Kinesiology, Health Promotion and RecreationUniversity of North TexasDentonTexasUSA
| | - Jeann Sabino‐Carvalho
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Elsa Mekonnen
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Melissa McGranahan
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Matias Zanuzzi
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Dana DaCosta
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Jeanie Park
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
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Junejo RT, Gupta D, Snowdon RL, Lip GYH, Fisher JP. Relationship of Warfarin and Apixaban with Vascular Function in Patients with Atrial Fibrillation. J Vasc Res 2024; 61:59-67. [PMID: 38447552 PMCID: PMC10997243 DOI: 10.1159/000535618] [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: 04/12/2023] [Accepted: 11/30/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is associated with endothelial damage/dysfunction. Herein, we tested the hypothesis that brachial artery flow-mediated dilation (FMD) is superior in AF patients taking apixaban compared to warfarin. METHODS AF patients on apixaban (n = 46; 67 [7] years; mean [standard deviation]; 15 women) and warfarin (n = 27; 73 [9] years (p < 0.01); 11 women) were recruited. Duplex Doppler ultrasound imaging was undertaken during baseline (2 min), cuff inflation (5 min), and following cuff deflation (3 min). FMD was defined as peak increase in brachial artery diameter following cuff deflation and analysed as percentage change in diameter, as a ratio of FMD, shear rate area under the curve (SRAUC; FMD-to-SRAUC), and using SRAUC as a covariate (FMDSR). RESULTS Baseline artery diameter (4.96 [1.14] vs. 4.89 [0.88] mm), peak diameter (5.12 [1.17] vs. 5.14 [0.93] mm), and FMDSR (3.89 [3.62] vs. 4.80 [3.60] %) were not different between warfarin and apixaban (p > 0.05; analysis of covariance with age, CHA2DS2-VASc, years since AF diagnosis, number of diabetics, alcohol drinkers, and units of alcohol consumed per week as covariates). Stepwise multiple regression identified independent association of fibrillation, hypertension, and increased age with FMD. CONCLUSION AF patients on warfarin and apixaban exhibit similar endothelium-dependent vasodilation. Increased blood pressure negatively impacts vasodilator capacity in AF patients.
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Affiliation(s)
- Rehan T Junejo
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK,
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK,
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Richard L Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, Manaaki Manawa - The Centre for Heart Research, University of Auckland, Auckland, New Zealand
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Ogoh S, Watanabe H, Saito S, Fisher JP, Iwamoto E. Can Alterations in Cerebrovascular CO 2 Reactivity Be Identified Using Transfer Function Analysis without the Requirement for Carbon Dioxide Inhalation? J Clin Med 2023; 12:jcm12062441. [PMID: 36983441 PMCID: PMC10051076 DOI: 10.3390/jcm12062441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
The present study aimed to examine the validity of a novel method to assess cerebrovascular carbon dioxide (CO2) reactivity (CVR) that does not require a CO2 inhalation challenge, e.g., for use in patients with respiratory disease or the elderly, etc. In twenty-one healthy participants, CVR responses to orthostatic stress (50° head-up tilt, HUT) were assessed using two methods: (1) the traditional CO2 inhalation method, and (2) transfer function analysis (TFA) between middle cerebral artery blood velocity (MCA V) and predicted arterial partial pressure of CO2 (PaCO2) during spontaneous respiration. During HUT, MCA V steady-state (i.e., magnitude) and MCA V onset (i.e., time constant) responses to CO2 inhalation were decreased (p < 0.001) and increased (p = 0.001), respectively, indicative of attenuated CVR. In contrast, TFA gain in the very low-frequency range (VLF, 0.005-0.024 Hz) was unchanged, while the TFA phase in the VLF approached zero during HUT (-0.38 ± 0.59 vs. 0.31 ± 0.78 radians, supine vs. HUT; p = 0.003), indicative of a shorter time (i.e., improved) response of CVR. These findings indicate that CVR metrics determined by TFA without a CO2 inhalation do not track HUT-evoked reductions in CVR identified using CO2 inhalation, suggesting that enhanced cerebral blood flow response to a change in CO2 using CO2 inhalation is necessary to assess CVR adequately.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe 350-8585, Japan
- Neurovascular Research Laboratory, University of South Wales, Pontypridd CF37 1DL, UK
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, Kawagoe 350-8585, Japan
| | - Shotaro Saito
- Department of Biomedical Engineering, Toyo University, Kawagoe 350-8585, Japan
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Erika Iwamoto
- School of Health Sciences, Sapporo Medical University, Sapporo 060-8556, Japan
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Saglietto A, Ballatore A, Xhakupi H, De Ferrari GM, Anselmino M. Association of Catheter Ablation and Reduced Incidence of Dementia among Patients with Atrial Fibrillation during Long-Term Follow-Up: A Systematic Review and Meta-Analysis of Observational Studies. J Cardiovasc Dev Dis 2022; 9:jcdd9050140. [PMID: 35621851 PMCID: PMC9143892 DOI: 10.3390/jcdd9050140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Atrial fibrillation (AF) is independently associated with the onset of cognitive decline/dementia. AF catheter ablation (AFCA) is the most effective treatment strategy in terms of sinus rhythm maintenance, but its effects on dementia prevention remain under investigation. The aim of the present study was to perform a systematic review and meta-analysis of the presently available studies exploring the effect of AFCA on dementia occurrence. Methods: PubMed/MEDLINE databases were screened for articles through 14 March 2022 reporting adjusted time-to-event outcome data comparing AFCA and non-AFCA cohorts in terms of de novo dementia occurrence. A random effect meta-analysis was performed to estimate the meta-analytic hazard ratio (HR) of dementia occurrence in AFCA vs. non-AFCA cohorts, as well as the meta-analytic incidence rate of dementia in the non-AFCA cohort. Based on the aforementioned estimates, the number needed to treat (NNT), projected at median follow-up, was derived. Results: Four observational studies were included in the analysis, encompassing 40,146 patients (11,312 in the AFCA cohort; 28,834 in the non-AFCA cohort). AFCA conferred a significant protection to the development of dementia with an overall HR of 0.52 (95% CI 0.35–0.76). The incidence rate of dementia in the non-AFCA group was 1.12 events per 100 person-year (95% CI 0.47–2.67). The derived NNT projected to the median follow-up (4.5 years) was 41. Conclusion: AFCA is associated with a nearly 50% reduction in dementia occurrence during a median 4.5-year follow-up. Future randomized clinical trials are needed to reinforce these findings.
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Atrial Fibrillation and Dementia: Epidemiological Insights on an Undervalued Association. Medicina (B Aires) 2022; 58:medicina58030361. [PMID: 35334537 PMCID: PMC8955523 DOI: 10.3390/medicina58030361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/18/2022] Open
Abstract
Background and objectives: Atrial fibrillation (AF) and dementia are growing causes of morbidity and mortality, representing relevant medical and socioeconomic burdens. In this study, based on data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) 2019, we focused on AF and dementia distribution and investigated the potential correlation between the two epidemiological trends. Materials and Methods: Crude and age-standardized incidence, prevalence, mortality rate, and disability-adjusted life years (DALYs) lost, derived from GBD 2019, were reported for AF and dementia. Global features were also stratified by high and low sociodemographic-index (SDI) countries. Granger test analysis was performed to investigate the correlation between AF and dementia incidence time trends. Results: From 1990 to 2019 crude worldwide incidence and prevalence showed a dramatic increase for both conditions (from 43.24 to 61.01 and from 528.72 to 771.51 per 100,000 individuals for AF, respectively; from 54.60 to 93.52 and from 369.88 to 667.2 per 100,000 individuals for dementia, respectively). In the same timeframe, crude mortality rate doubled for AF and dementia (from 2.19 to 4.08, and from 10.49 to 20.98 per 100,000 individuals, respectively). Age-standardized estimate showed a substantial stability over the years, highlighting the key role of the progressively aging population. Crude estimates of all of the investigated metrics are greater in high SDI countries for both conditions. This association was still valid for age-standardized metrics, albeit by a reduced magnitude, suggesting the presence of higher risk factor burden in these countries. Finally, according to Granger test, we found a significant association between the historical trends of AF and dementia incidence (p = 0.004). Conclusions: AF and dementia burden progressively increased in the last three decades. Given the potential association between these two conditions, further clinical data assessing this relationship is needed.
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van der Ster BJP, Kim YS, Westerhof BE, van Lieshout JJ. Central Hypovolemia Detection During Environmental Stress-A Role for Artificial Intelligence? Front Physiol 2021; 12:784413. [PMID: 34975538 PMCID: PMC8715014 DOI: 10.3389/fphys.2021.784413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
The first step to exercise is preceded by the required assumption of the upright body position, which itself involves physical activity. The gravitational displacement of blood from the chest to the lower parts of the body elicits a fall in central blood volume (CBV), which corresponds to the fraction of thoracic blood volume directly available to the left ventricle. The reduction in CBV and stroke volume (SV) in response to postural stress, post-exercise, or to blood loss results in reduced left ventricular filling, which may manifest as orthostatic intolerance. When termination of exercise removes the leg muscle pump function, CBV is no longer maintained. The resulting imbalance between a reduced cardiac output (CO) and a still enhanced peripheral vascular conductance may provoke post-exercise hypotension (PEH). Instruments that quantify CBV are not readily available and to express which magnitude of the CBV in a healthy subject should remains difficult. In the physiological laboratory, the CBV can be modified by making use of postural stressors, such as lower body "negative" or sub-atmospheric pressure (LBNP) or passive head-up tilt (HUT), while quantifying relevant biomedical parameters of blood flow and oxygenation. Several approaches, such as wearable sensors and advanced machine-learning techniques, have been followed in an attempt to improve methodologies for better prediction of outcomes and to guide treatment in civil patients and on the battlefield. In the recent decade, efforts have been made to develop algorithms and apply artificial intelligence (AI) in the field of hemodynamic monitoring. Advances in quantifying and monitoring CBV during environmental stress from exercise to hemorrhage and understanding the analogy between postural stress and central hypovolemia during anesthesia offer great relevance for healthy subjects and clinical populations.
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Affiliation(s)
- Björn J. P. van der Ster
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yu-Sok Kim
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Berend E. Westerhof
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Johannes J. van Lieshout
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Laboratory for Clinical Cardiovascular Physiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, The Medical School, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
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Cruz L, Silva A, Lopes J, Damas D, Lourenço J, Costa A, Silva F, Sousa J, Galego O, Nunes C, Veiga R, Machado C, Rodrigues B, Cecilia C, Almendra L, Bras A, Santo G, Machado E, Sargento-Freitas J. Early Cerebrovascular Ultrasonography as a Predictor of Hemorrhagic Transformation After Thrombectomy. J Stroke Cerebrovasc Dis 2021; 30:105922. [PMID: 34157670 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To determine the predictive value of early transcranial color-coded sonography (TCCS) for intracranial hemorrhage (ICH) in patients with large artery occlusion (LAO) stroke of carotid circulation, who were submitted to endovascular therapy (EVT) with successful reperfusion. MATERIALS AND METHODS Retrospective study evaluating a cohort of consecutive stroke patients with LAO of the carotid circulation that were recanalyzed with EVT. We measured angle-corrected peak systolic velocities, end-diastolic velocities and mean flow velocities (PSV, EDV and MFV) of the symptomatic and asymptomatic middle cerebral artery (MCA). The ratio between MFV of the symptomatic MCA and MFV of the asymptomatic MCA (MCA-Ra) was calculated. Parenchymal hematoma in the 24 hours control CT was considered as ICH. Univariate associations and multivariate analyses were used to identify early independent predictors for ICH among TCCS findings. RESULTS We included 234 patients, mean age 72.5 (SD 12.6) years, 52.1% male. The mean time between recanalization and TCCS was 12.3 hours (range 3-22). Patients who developed postinterventional ICH showed a higher MCA-Ra (1.02 ± 0.26 vs 1.16 ± 0,21, p = 0.036). In multivariate analysis, only higher MCA-Ra remained independently associated with postinterventional ICH (OR: 6.778, 95%CI: 1.152-39.892, p = 0.034). A value of MCA-Ra ≥ 1,05 was associated with ICH, showing a sensitivity of 81.3% and a specificity of 65.9%; the AUC based of the ROC analysis was 0.688 (95% CI 0.570-0.806). CONCLUSION TCCS performed within the first 24 hours after stroke onset can help to predict hemorrhagic transformation in patients with LAO.
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Affiliation(s)
- L Cruz
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - D Damas
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Lourenço
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - A Costa
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - F Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - O Galego
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Nunes
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - R Veiga
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Machado
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Rodrigues
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Cecilia
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Almendra
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Bras
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - G Santo
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Machado
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Sargento-Freitas
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Saglietto A, Scarsoglio S, Canova D, Roatta S, Gianotto N, Piccotti A, Franzin S, Gaita F, De Ferrari GM, Ridolfi L, Anselmino M. Increased beat-to-beat variability of cerebral microcirculatory perfusion during atrial fibrillation: a near-infrared spectroscopy study. Europace 2021; 23:1219-1226. [PMID: 33846732 DOI: 10.1093/europace/euab070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/06/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Atrial fibrillation (AFib) is associated with cognitive decline/dementia, independently from clinical strokes or transient ischaemic attacks (TIA). Recent in silico data suggested that AFib may induce transient critical haemodynamic events in the cerebral microcirculation. The aim of this study is to use non-invasive spatially resolved cerebral near-infrared spectroscopy (SRS-NIRS) to investigate in vivo beat-to-beat microcirculatory perfusion during AFib and after sinus rhythm (SR) restoration. METHODS AND RESULTS Cerebral SRS-NIRS with high-frequency sampling (20 Hz) and non-invasive systemic haemodynamic monitoring were recorded before and after elective electrical cardioversion (ECV) for AFib or atrial flutter (AFL). To assess beat-to-beat effects of the rhythm status, the frequency distribution of inter-beat differences in tissue haemoglobin index (THI), a proxy of microcirculatory cerebral perfusion, was compared before and after SR restoration. Fifty-three AFib/AFL patients (mean age 69 ± 8 years, 79% males) were ultimately enrolled. Cardioversion was successful in restoring SR in 51 (96%) patients. In front of a non-significant decrease in arterial blood pressure extreme events between pre- and post-ECV measurements, a significant decrease of both hypoperfusive and hyperperfusive/hypertensive microcirculatory events was observed after SR restoration (P < 0.001 and P = 0.041, respectively). CONCLUSION The present is the first in vivo demonstration that SR restoration by ECV significantly reduces the burden of extreme single-beat haemodynamic events in cerebral microcirculation. Future studies are needed to assess whether SR maintenance might slow long-term AFib-correlated cognitive decline/dementia.
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin, Italy
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Daniela Canova
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin, Italy
| | | | - Nefer Gianotto
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin, Italy
| | - Alessandro Piccotti
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin, Italy
| | - Simone Franzin
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Fiorenzo Gaita
- Cardiovascular Department, Clinica Pinna Pintor, Policlinico di Monza, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza di Torino' Hospital, University of Turin, Turin, Italy
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11
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Junejo RT, Lip GYH, Fisher JP. Cerebrovascular Dysfunction in Atrial Fibrillation. Front Physiol 2020; 11:1066. [PMID: 33013456 PMCID: PMC7509200 DOI: 10.3389/fphys.2020.01066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 01/13/2023] Open
Abstract
It is now well established that besides being the most common sustained arrhythmia, atrial fibrillation (AF) is a major healthcare burden. Risk of debilitating stroke is increased in AF patients, but even in the absence of stroke, this population is at heightened risk of cognitive decline, depression, and dementia. The reasons for this are complex, multifactorial, and incompletely understood. One potential contributing mechanism is cerebrovascular dysfunction. Cerebral blood flow is regulated by chemical, metabolic, autoregulatory, neurogenic, and systemic factors. The dysfunction in one or more of these mechanisms may contribute to the elevated risk of cognitive decline and cerebrovascular events in AF. This short review presents the evidence for diminished cerebral blood flow, cerebrovascular carbon dioxide reactivity (i.e., cerebrovascular vasodilatory reserve), cerebral autoregulation, and neurovascular coupling in AF patients when compared to control participants in sinus rhythm. Further work is needed to understand the physiological mechanisms underpinning these observations and their clinical significance in atrial fibrillation patients.
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Affiliation(s)
- Rehan T Junejo
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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12
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Junejo RT, Braz ID, Lucas SJ, van Lieshout JJ, Phillips AA, Lip GY, Fisher JP. Neurovascular coupling and cerebral autoregulation in atrial fibrillation. J Cereb Blood Flow Metab 2020; 40:1647-1657. [PMID: 31426699 PMCID: PMC7370373 DOI: 10.1177/0271678x19870770] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The risk of cognitive decline and stroke is increased by atrial fibrillation (AF). We sought to determine whether neurovascular coupling and cerebral autoregulation are blunted in people with AF in comparison with age-matched, patients with hypertension and healthy controls. Neurovascular coupling was assessed using five cycles of visual stimulation for 30 s followed by 30 s with both eyes-closed. Cerebral autoregulation was examined using a sit-stand test, and a repeated squat-to-stand (0.1 Hz) manoeuvre with transfer function analysis of mean arterial pressure (MAP; input) and middle cerebral artery mean blood flow velocity (MCA Vm; output) relationships at 0.1 Hz. Visual stimulation increased posterior cerebral artery conductance, but the magnitude of the response was blunted in patients with AF (18 [8] %; mean [SD]) and hypertension (17 [8] %), in comparison with healthy controls (26 [9] %) (P < 0.05). In contrast, transmission of MAP to MCA Vm was greater in AF patients compared to hypertension and healthy controls, indicating diminished cerebral autoregulation. We have shown for the first time that AF patients have impaired neurovascular coupling responses to visual stimulation and diminished cerebral autoregulation. Such deficits in cerebrovascular regulation may contribute to the increased risk of cerebral dysfunction in people with AF.
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Affiliation(s)
- Rehan T Junejo
- School of Sport, Exercise & Rehabilitation Sciences, College of Life & Environmental Sciences, University of Birmingham, Birmingham, UK.,Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Igor D Braz
- Medical School, University Center of Volta Redonda, Volta Redonda, Brazil
| | - Samuel Je Lucas
- School of Sport, Exercise & Rehabilitation Sciences, College of Life & Environmental Sciences, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, College of Life & Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Johannes J van Lieshout
- Department of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Clinical Cardiovascular Physiology, AMC Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Aaron A Phillips
- Departments of Physiology, Pharmacology & Clinical Neurosciences, Libin Cardiovascular Institute, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - James P Fisher
- School of Sport, Exercise & Rehabilitation Sciences, College of Life & Environmental Sciences, University of Birmingham, Birmingham, UK.,Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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13
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Hu T, Noheria A, Asirvatham SJ. Atrial Fibrillation and Falls: A Mechanistic or Age-Confounded Relationship? Mayo Clin Proc 2020; 95:632-635. [PMID: 32247334 DOI: 10.1016/j.mayocp.2020.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Tiffany Hu
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amit Noheria
- Department of Cardiovascular Medicine, Division of Electrophysiology, University of Kansas, Kansas City, KS
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN.
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14
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Burley CV, Lucas RAI, Whittaker AC, Mullinger K, Lucas SJE. The CO 2 stimulus duration and steady-state time point used for data extraction alters the cerebrovascular reactivity outcome measure. Exp Physiol 2020; 105:893-903. [PMID: 32083357 DOI: 10.1113/ep087883] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 02/19/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Cerebrovascular reactivity (CVR) is a common functional test to assess brain health, and impaired CVR has been associated with all-cause cardiovascular mortality: does the duration of the CO2 stimulus and the time point used for data extraction alter the CVR outcome measure? What is the main finding and its importance? This study demonstrated CVR measures calculated from 1 and 2 min CO2 stimulus durations were significantly higher than CVR calculated from a 4 min CO2 stimulus. CVRs calculated from the first 2 min of the CO2 stimulus were significantly higher than CVR values calculated from the final minute if the duration was ≥4 min. This study highlights the need for consistent methodological approaches. ABSTRACT Cerebrovascular reactivity to carbon dioxide (CVR) is a common functional test to assess brain vascular health, though conflicting age and fitness effects have been reported. Studies have used different CO2 stimulus durations to induce CVR and extracted data from different time points for analysis. Therefore, this study examined whether these differences alter CVR and explain conflicting findings. Eighteen healthy volunteers (24 ± 5 years) inhaled CO2 for four stimulus durations (1, 2, 4 and 5 min) of 5% CO2 (in air) via the open-circuit Douglas bag method, in a randomized order. CVR data were derived from transcranial Doppler (TCD) measures of middle cerebral artery blood velocity (MCAv), with concurrent ventilatory sensitivity to the CO2 stimulus ( V ̇ E , C O 2 ). Repeated measures ANOVAs compared CVR and V ̇ E , C O 2 measures between stimulus durations and steady-state time points. An effect of stimulus duration was observed (P = 0.002, η² = 0.140), with 1 min (P = 0.010) and 2 min (P < 0.001) differing from 4 min, and 2 min differing from 5 min (P = 0.019) durations. V ̇ E , C O 2 sensitivity increased ∼3-fold from 1 min to 4 and 5 min durations (P < 0.001, η² = 0.485). CVRs calculated from different steady-state time points within each stimulus duration were different (P < 0.001, η² = 0.454), specifically for 4 min (P = 0.001) and 5 min (P < 0.001), but not 2 min stimulus durations (P = 0.273). These findings demonstrate that methodological differences alter the CVR measure.
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Affiliation(s)
- Claire V Burley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Anna C Whittaker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Karen Mullinger
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK.,School of Psychology, University of Birmingham, Birmingham, UK.,School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK.,Department of Physiology, University of Otago, New Zealand
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15
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Junejo RT, May S, Alsalahi S, Alali M, Ogoh S, Fisher JP. Cerebrovascular carbon dioxide reactivity and flow-mediated dilation in young healthy South Asian and Caucasian European men. Am J Physiol Heart Circ Physiol 2020; 318:H756-H763. [PMID: 32083976 DOI: 10.1152/ajpheart.00641.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
South Asians living in the United Kingdom have a 1.5-fold greater risk of ischemic stroke than the general population. Impaired cerebrovascular carbon dioxide (CO2) reactivity is an independent predictor of ischemic stroke and cardiovascular mortality. We sought to test the hypothesis that cerebrovascular CO2 reactivity is reduced in South Asians. Middle cerebral artery blood velocity (MCA Vm) was measured at rest and during stepwise changes in end-tidal partial pressure of CO2 (PETCO2) in South Asian (n = 16) and Caucasian European (n = 18) men who were young (~20 yr), healthy, and living in the United Kingdom. Incremental hypercapnia was delivered via the open-circuit steady-state method, with stages of 4 and 7% CO2 (≈21% oxygen, nitrogen balanced). Cerebrovascular CO2 reactivity was calculated as the change in MCA Vm relative to the change in PETCO2. MCA Vm was not different in South Asians [59 (9) cm/s, mean (standard deviation)] and Caucasian Europeans [61 (12) cm/s; P > 0.05]. Similarly, cerebrovascular CO2 reactivity was not different between the groups [South Asian 2.53 (0.76) vs. Caucasian European 2.61 (0.81) cm·s-1·mmHg-1; P > 0.05]. Brachial artery flow-mediated dilation was lower in South Asians [5.48 (2.94)%] compared with Caucasian Europeans [7.41 (2.28)%; P < 0.05]; however, when corrected for shear rate no between-group differences in flow-mediated dilation were observed (P > 0.05). Flow-mediated dilation was not correlated with cerebrovascular CO2 reactivity measures. In summary, cerebrovascular CO2 reactivity and flow-mediated dilation corrected for shear rate are preserved in young healthy South Asian men living in the United Kingdom.NEW & NOTEWORTHY Previous reports have identified an increased risk of ischemic stroke and peripheral endothelial dysfunction in South Asians compared with Caucasian Europeans. The main finding of this study is that cerebrovascular carbon dioxide reactivity (an independent predictor of ischemic stroke) is not different in healthy young South Asian and Caucasian European men.
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Affiliation(s)
- Rehan T Junejo
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.,Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Sophie May
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sultan Alsalahi
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mohammad Alali
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Saitama, Japan
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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16
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Sumida H, Yasunaga Y, Takasawa K, Tanaka A, Ida S, Saito T, Sugiyama S, Matsui K, Nakao K, Tsujita K, Tohya Y. Cognitive function in post-cardiac intensive care: patient characteristics and impact of multidisciplinary cardiac rehabilitation. Heart Vessels 2020; 35:946-956. [PMID: 32052162 DOI: 10.1007/s00380-020-01566-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/24/2020] [Indexed: 01/18/2023]
Abstract
New/worsening cognitive and physical impairments following critical care pose significant problems. Multidisciplinary cardiac rehabilitation (CR) can improve physical function after cardiac intensive care (CIC). This observational study aimed to evaluate cognitive function in patients participating in multidisciplinary CR and to identify correlates of impaired cognitive function after CIC. We analyzed 111 consecutive patients admitted to our comprehensive care ward at least 7 days after CIC and assessed factors associated with cognitive function using the Functional Independence Measure (FIM). Patients were stratified into two groups based on the median FIM-Cognitive scores: impaired (n = 56) and preserved cognition (n = 55) groups. Multiple logistic regression analysis identified age [odds ratio (OR) 1.06; 95% confidence interval (CI) 1.00-1.13; p = 0.042], Mini-Nutrition Assessment-Short Form (MNA-SF; OR 0.73; 95% CI 0.56-0.95; p = 0.017), and FIM-Physical scores (OR: 0.94; 95% CI 0.90-0.99; p = 0.012) as significant and independent factors associated with impaired cognition. The median length of hospital stay was 28 (interquartile range: 18, 43) days. The FIM-Cognitive and FIM-Physical scores significantly increased from admission to discharge [32.0 (27.0, 35.0) vs. 34.0 (29.0, 35.0) points; p < 0.001; 67.0 (53.0, 75.0) vs. 85.0 (73.5, 89.0) points; p < 0.001, respectively]. On subgroup analysis within the impaired cognition group, increased FIM-Cognitive scores positively and significantly correlated with increased FIM-Physical scores (ρ = 0.450; p = 0.001). Multiple linear regression analysis identified atrial fibrillation (AF; β = - 0.29; p = 0.016), ln(glycated hemoglobin; HbA1c) (β = 0.29; p = 0.018), and ln(high-sensitivity C-reactive protein; hs-CRP) (β = - 0.26; p = 0.034) as significant and independent factors correlated with increased FIM-Cognitive scores. In conclusion, advanced age, low MNA-SF score, and FIM-Physical score were independent factors associated with impaired cognition in post-CIC patients. Multidisciplinary CR improved both physical and cognitive functions, and AF, HbA1c, and hs-CRP were independent factors correlated with increased FIM-Cognitive score.
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Affiliation(s)
- Hitoshi Sumida
- Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan.
| | - Yuichi Yasunaga
- Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan
| | - Kensei Takasawa
- Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan
| | - Aya Tanaka
- Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan
| | - Seiko Ida
- Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan
| | - Tadaoki Saito
- Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan
| | - Seigo Sugiyama
- Division of Cardiology, Jinnouchi Hospital, 6-2-3, Kuhonji Chuo-ku, Kumamoto, 862-0976, Japan
| | - Kunihiko Matsui
- Department of Community, Family, and General Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-ku, Kumamoto, 862-8556, Japan
| | - Koichi Nakao
- Department of Cardiovascular Medicine, Saiseikai Kumamoto Hospital, 5-3-1, Chikami Minami-ku, Kumamoto, 862-4116, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-ku, Kumamoto, 862-8556, Japan
| | - Yuji Tohya
- Division of Cardiology, Heisei Tohya Hospital, 8-2-15, Idenakama Minami-ku, Kumamoto, 862-0963, Japan
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17
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Vlastra W, van den Boogert TPW, Krommenhoek T, Bronzwaer ASGT, Mutsaerts HJMM, Achterberg HC, Bron EE, Niessen WJ, Majoie CBLM, Nederveen AJ, Baan J, van Lieshout JJ, Piek JJ, Planken RN, Henriques JPS, Delewi R. Aortic valve calcification volumes and chronic brain infarctions in patients undergoing transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2019; 35:2123-2133. [PMID: 31312998 PMCID: PMC6805808 DOI: 10.1007/s10554-019-01663-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
Chronic silent brain infarctions, detected as new white matter hyperintensities on magnetic resonance imaging (MRI) following transcatheter aortic valve implantation (TAVI), are associated with long-term cognitive deterioration. This is the first study to investigate to which extent the calcification volume of the native aortic valve (AV) measured with cardiac computed tomography angiography (CTA) predicts the increase in chronic white matter hyperintensity volume after TAVI. A total of 36 patients (79 ± 5 years, median EuroSCORE II 1.9%, Q1–Q3 1.5–3.4%) with severe AV stenosis underwent fluid attenuation inversion recovery (FLAIR) MRI < 24 h prior to TAVI and at 3 months follow-up for assessment of cerebral white matter hyperintensity volume (mL). Calcification volumes (mm3) of the AV, aortic arch, landing zone and left ventricle were measured on the CTA pre-TAVI. The largest calcification volumes were found in the AV (median 692 mm3) and aortic arch (median 633 mm3), with a large variation between patients (Q1–Q3 482–1297 mm3 and 213–1727 mm3, respectively). The white matter hyperintensity volume increased in 72% of the patients. In these patients the median volume increase was of 1.1 mL (Q1–Q3 0.3–4.6 mL), corresponding with a 27% increase from baseline (Q1–Q3 7–104%). The calcification volume in the AV predicted the increase of white matter hyperintensity volume (Δ%), with a 35% increase of white matter hyperintensity volume, per 100 mm3 of AV calcification volume (SE 8.5, p < 0.001). The calcification volumes in the aortic arch, landing zone and left ventricle were not associated with the increase in white matter hyperintensity volume. In 72% of the patients new chronic white matter hyperintensities developed 3 months after TAVI, with a median increase of 27%. A higher calcification volume in the AV was associated with a larger increase in the white matter hyperintensity volume. These findings show the potential for automated AV calcium screening as an imaging biomarker to predict chronic silent brain infarctions.
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Affiliation(s)
- Wieneke Vlastra
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Thomas P W van den Boogert
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Thomas Krommenhoek
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Anne-Sophie G T Bronzwaer
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC and VUmc, University of Amsterdam, Amsterdam, The Netherlands
| | - Hakim C Achterberg
- Department of Radiology & Nuclear Medicine, Biomedical Imaging Group Rotterdam, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther E Bron
- Department of Radiology & Nuclear Medicine, Biomedical Imaging Group Rotterdam, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Radiology & Nuclear Medicine, Biomedical Imaging Group Rotterdam, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC and VUmc, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC and VUmc, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Johannes J van Lieshout
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Life Sciences, The Medical School, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC and VUmc, University of Amsterdam, Amsterdam, The Netherlands
| | - José P S Henriques
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands.
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