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Cai J, Zhang N, Cui Y, Ning Y, Wu Q, Zhang Y, Chen H. Baseline systolic blood pressure, hypertension history, and efficacy of remote ischemic conditioning. Ann Clin Transl Neurol 2024; 11:1703-1714. [PMID: 38831636 PMCID: PMC11251468 DOI: 10.1002/acn3.52077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/14/2024] [Accepted: 04/09/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE We performed a post hoc exploratory analysis of Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke (RICAMIS) to determine whether hypertension history and baseline systolic blood pressure (SBP) affect the efficacy of remote ischemic conditioning (RIC). METHODS Based on the full analysis set of RICAMIS, patients were divided into hypertension versus non-hypertension group, or <140 mmHg versus ≥140 mmHg group. Each group was further subdivided into RIC and control subgroups. The primary outcome was modified Rankin Scale (mRS) 0-1 at 90 days. Efficacy of RIC was compared among patients with hypertension versus nonhypertension history and SBP of <140 mmHg versus ≥140 mmHg. Furthermore, the interaction effect of treatment with hypertension and SBP was assessed. RESULTS Compared with control group, RIC produced a significantly higher proportion of patients with excellent functional outcome in the nonhypertension group (RIC vs. control: 65.7% vs. 57.0%, OR 1.45, 95% CI 1.06-1.98; p = 0.02), but no significant difference was observed in the hypertension group (RIC vs. control: 69.1% vs. 65.2%, p = 0.17). Similar results were observed in SBP ≥140 mmHg group (RIC vs. control: 68.0% vs. 61.2%, p = 0.009) and SBP <140 mmHg group (RIC vs. control: 65.6% vs. 64.7%, p = 0.77). No interaction effect of RIC on primary outcome was identified. INTERPRETATION Hypertension and baseline SBP did not affect the neuroprotective effect of RIC, but they were associated with higher probability of excellent functional outcome in patients with acute moderate ischemic stroke who received RIC treatment.
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Affiliation(s)
- Ji‐Ru Cai
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
- Department of NeurologyPostgraduate Training Base of Jinzhou Medical University in the General Hospital of Northern Theater CommandShenyangChina
| | - Nan‐Nan Zhang
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Yu Cui
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Yue‐Xin Ning
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Qiong Wu
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Yi‐Na Zhang
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Hui‐Sheng Chen
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
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2
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Rasti SD, Sugiarto AAR, Nuryandi APA, Arvianti MZ, Yomara RT, Nagasastra J, Julario R, Fagi RA, Windrati DMH. Revitalizing brain perfusion: Unveiling advancements through rhythm control strategies in atrial fibrillation-A systematic review. J Arrhythm 2024; 40:411-422. [PMID: 38939785 PMCID: PMC11199798 DOI: 10.1002/joa3.13056] [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: 01/25/2024] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 06/29/2024] Open
Abstract
Background Recent evidence suggests an elevated risk of cognitive impairment and dementia in individuals with atrial fibrillation (AF), irrespective of stroke occurrence. AF, known to reduce brain perfusion, particularly through silent cerebral ischemia, underscores the intricate relationship between cardiac and cerebral health. The heart plays a crucial role in supporting normal brain function, and rhythm control, a standard AF treatment, has demonstrated enhancements in brain perfusion. This systematic review aimed to examine published data concerning the influence of rhythm control on brain perfusion in patients with atrial fibrillation. Methods A systematic search for relevant studies was carried out in Scopus, PubMed, Cochrane Reviews, ProQuest, and EBSCOhost, spanning from their inception until April 30, 2023. Studies that specifically examined brain perfusion following any form of rhythm control in atrial fibrillation were included in the review. Results The review encompassed 10 studies involving 436 participants. Among these, six utilized electrical cardioversion for rhythm control. The majority (8 out of 10) demonstrated that restoring sinus rhythm markedly enhances brain perfusion. In one of the two remaining studies, notable improvement was observed specifically in a region closely linked to cognition. Additionally, both studies reporting data on the Mini-Mental State Examination (MMSE) showed a consistent and significant increase in scores following rhythm control. Conclusion Successful rhythm control in AF emerges as a significant contributor to enhanced brain perfusion, suggesting a potential therapeutic avenue for reducing cognitive impairment incidence. However, further validation through larger prospective studies and randomized trials is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Rerdin Julario
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital, Faculty of Medicine, University of AirlanggaSurabayaIndonesia
| | - Rosi Amrilla Fagi
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital, Faculty of Medicine, University of AirlanggaSurabayaIndonesia
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3
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Wu J, Wang H, Wang N, Wang Z, Zhu Q. TIE2 expression in hypertensive ICH and its therapeutic modulation with AKB-9778: Implications for brain vascular health. Exp Neurol 2024; 374:114685. [PMID: 38195021 DOI: 10.1016/j.expneurol.2024.114685] [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: 09/25/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/11/2024]
Abstract
Hypertensive intracerebral hemorrhage (ICH) is a devastating condition, the molecular underpinnings of which remain not fully understood. By leveraging high-throughput transcriptome sequencing and network pharmacology analysis, this study unveils the significant role of the tyrosine kinase with immunoglobulin-like and EGF-like domains 2 (TIE2) in ICH pathogenesis. Compared to controls, a conspicuous downregulation of TIE2 was observed in the cerebral blood vessels of hypertensive ICH mice. In vitro assays with human brain microvascular endothelial cells (HBMEC), HBEC-5i revealed that modulation of TIE2 expression significantly influences cellular proliferation, migration, and angiogenesis, mediated via the Rap1/MEK/ERK signaling pathway. Notably, the small molecule AKB-9778 was identified to target and activate TIE2, affecting the functional attributes of HBEC-5i. In vivo experiments further demonstrated that combining AKB-9778 with antihypertensive drugs could mitigate the incidence and volume of bleeding in hypertensive ICH mouse models, suggesting potential therapeutic implications.
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Affiliation(s)
- Jingkun Wu
- Department of Neurosurgery, Affiliated Hospital of Hebei Engineering University, Handan 056002, PR China
| | - Hongbin Wang
- Department of Neurosurgery, Affiliated Hospital of Hebei Engineering University, Handan 056002, PR China
| | - Naizhu Wang
- Department of Neurosurgery, Affiliated Hospital of Hebei Engineering University, Handan 056002, PR China
| | - Zai Wang
- Science and Education Division, Affiliated Hospital of Hebei Engineering University, Handan 056002, PR China
| | - Qinghua Zhu
- Department of Neurosurgery, Affiliated Hospital of Hebei Engineering University, Handan 056002, PR China.
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4
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Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Brenner EK, Banks SJ, Gilbert PE, Nation DA, Delano-Wood L, Bondi MW, Bangen KJ. Pulse pressure and APOE ε4 dose interact to affect cerebral blood flow in older adults without dementia. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100206. [PMID: 38328026 PMCID: PMC10847851 DOI: 10.1016/j.cccb.2024.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
This study assessed whether the effect of vascular risk on cerebral blood flow (CBF) varies by gene dose of apolipoprotein (APOE) ε4 alleles. 144 older adults without dementia from the Alzheimer's Disease Neuroimaging Initiative underwent arterial spin labeling and T1-weighted MRI, APOE genotyping, fluorodeoxyglucose positron emission tomography (FDG-PET), lumbar puncture, and blood pressure (BP) assessment. Vascular risk was assessed using pulse pressure (systolic BP - diastolic BP). CBF was examined in six AD-vulnerable regions: entorhinal cortex, hippocampus, inferior temporal cortex, inferior parietal cortex, rostral middle frontal gyrus, and medial orbitofrontal cortex. Linear regressions tested the interaction between APOE ε4 dose and pulse pressure on CBF in each region, adjusting for age, sex, cognitive classification, antihypertensive medication use, FDG-PET, reference CBF region, and AD biomarker positivity. There was a significant interaction between pulse pressure and APOE ɛ4 dose on CBF in the entorhinal cortex, hippocampus, and inferior parietal cortex, such that higher pulse pressure was associated with lower CBF only among ε4 homozygous participants. These findings demonstrate that the association between pulse pressure and regional CBF differs by APOE ε4 dose, suggesting that targeting modifiable vascular risk factors may be particularly important for those genetically at risk for AD.
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Affiliation(s)
- Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer's Institute, Tucson, AZ, USA
- Departments of Neurology and Psychology, University of Arizona, Tucson, AZ, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Einat K. Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sarah J. Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Paul E. Gilbert
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Daniel A. Nation
- Department of Psychology, University of California Irvine, Irvine, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Yetim E, Jacoby J, Damestani NL, Lovely AE, Salat DH, Juttukonda MR. Mean Arterial Pressure and Cerebral Hemodynamics Across The Lifespan: A Cross-Sectional Study From Human Connectome Project-Aging. J Magn Reson Imaging 2023; 58:1892-1900. [PMID: 37040498 PMCID: PMC10564963 DOI: 10.1002/jmri.28722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Cerebral perfusion is directly affected by systemic blood pressure, which has been shown to be negatively correlated with cerebral blood flow (CBF). The impact of aging on these effects is not fully understood. PURPOSE To determine whether the relationship between mean arterial pressure (MAP) and cerebral hemodynamics persists throughout the lifespan. STUDY TYPE Retrospective, cross-sectional study. POPULATION Six hundred and sixty-nine participants from the Human Connectome Project-Aging ranging between 36 and 100+ years and without a major neurological disorder. FIELD STRENGTH/SEQUENCE Imaging data was acquired at 3.0 Tesla using a 32-channel head coil. CBF and arterial transit time (ATT) were measured by multi-delay pseudo-continuous arterial spin labeling. ASSESSMENT The relationships between cerebral hemodynamic parameters and MAP were evaluated globally in gray and white matter and regionally using surface-based analysis in the whole group, separately within different age groups (young: <60 years; younger-old: 60-79 years; oldest-old: ≥80 years). STATISTICAL TESTS Chi-squared, Kruskal-Wallis, ANOVA, Spearman rank correlation and linear regression models. The general linear model setup in FreeSurfer was used for surface-based analyses. P < 0.05 was considered significant. RESULTS Globally, there was a significant negative correlation between MAP and CBF in both gray (ρ = -0.275) and white matter (ρ = -0.117). This association was most prominent in the younger-old [gray matter CBF (β = -0.271); white matter CBF (β = -0.241)]. In surface-based analyses, CBF exhibited a widespread significant negative association with MAP throughout the brain, whereas a limited number of regions showed significant prolongation in ATT with higher MAP. The associations between regional CBF and MAP in the younger-old showed a different topographic pattern in comparison to young subjects. DATA CONCLUSION These observations further emphasize the importance of cardiovascular health in mid-to-late adulthood for healthy brain aging. The differences in the topographic pattern with aging indicate a spatially heterogeneous relationship between high blood pressure and CBF. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Ezgi Yetim
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown MA
| | - John Jacoby
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown MA
| | - Nikou L. Damestani
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown MA
- Department of Radiology, Harvard Medical School, Boston MA
| | - Allison E. Lovely
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown MA
| | - David H. Salat
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown MA
- Department of Radiology, Harvard Medical School, Boston MA
- Neuroimaging for Veterans Center, VA Boston Healthcare System, Boston MA
| | - Meher R. Juttukonda
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown MA
- Department of Radiology, Harvard Medical School, Boston MA
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Laporte JP, Faulkner ME, Gong Z, Akhonda MA, Ferrucci L, Egan JM, Bouhrara M. Hypertensive Adults Exhibit Lower Myelin Content: A Multicomponent Relaxometry and Diffusion Magnetic Resonance Imaging Study. Hypertension 2023; 80:1728-1738. [PMID: 37283066 PMCID: PMC10355798 DOI: 10.1161/hypertensionaha.123.21012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND It is unknown whether hypertension plays any role in cerebral myelination. To fill this knowledge gap, we studied 90 cognitively unimpaired adults, age range 40 to 94 years, who are participants in the Baltimore Longitudinal Study of Aging and the Genetic and Epigenetic Signatures of Translational Aging Laboratory Testing to look for potential associations between hypertension and cerebral myelin content across 14 white matter brain regions. METHODS Myelin content was probed using our advanced multicomponent magnetic resonance relaxometry method of myelin water fraction, a direct and specific magnetic resonance imaging measure of myelin content, and longitudinal and transverse relaxation rates (R1 and R2), 2 highly sensitive magnetic resonance imaging metrics of myelin content. We also applied diffusion tensor imaging magnetic resonance imaging to measure fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity values, which are metrics of cerebral microstructural tissue integrity, to provide context with previous magnetic resonance imaging findings. RESULTS After adjustment of age, sex, systolic blood pressure, smoking status, diabetes status, and cholesterol level, our results indicated that participants with hypertension exhibited lower myelin water fraction, fractional anisotropy, R1 and R2 values and higher mean diffusivity, radial diffusivity, and axial diffusivity values, indicating lower myelin content and higher impairment to the brain microstructure. These associations were significant across several white matter regions, particularly in the corpus callosum, fronto-occipital fasciculus, temporal lobes, internal capsules, and corona radiata. CONCLUSIONS These original findings suggest a direct association between myelin content and hypertension and form the basis for further investigations including longitudinal assessments of this relationship.
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Affiliation(s)
- John P. Laporte
- Laboratory of Clinical Investigation (J.P.L., M.E.F., Z.G., M.A.B.S.A., J.M.E., M.B.), National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Mary E. Faulkner
- Laboratory of Clinical Investigation (J.P.L., M.E.F., Z.G., M.A.B.S.A., J.M.E., M.B.), National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Zhaoyuan Gong
- Laboratory of Clinical Investigation (J.P.L., M.E.F., Z.G., M.A.B.S.A., J.M.E., M.B.), National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Mohammad A.B.S. Akhonda
- Laboratory of Clinical Investigation (J.P.L., M.E.F., Z.G., M.A.B.S.A., J.M.E., M.B.), National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Luigi Ferrucci
- Translational Gerontology Branch (L.F.), National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Josephine M. Egan
- Laboratory of Clinical Investigation (J.P.L., M.E.F., Z.G., M.A.B.S.A., J.M.E., M.B.), National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Mustapha Bouhrara
- Laboratory of Clinical Investigation (J.P.L., M.E.F., Z.G., M.A.B.S.A., J.M.E., M.B.), National Institute on Aging, National Institutes of Health, Baltimore, MD
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7
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Kedžo J, Lovrić Kojundžić S, Marinović Guić M, Tandara L, Brešković T, Jurišić Z. Association of Electrical Cardioversion with Brain Perfusion and Cognitive Function in Patients with Atrial Fibrillation. Life (Basel) 2023; 13:935. [PMID: 37109463 PMCID: PMC10142430 DOI: 10.3390/life13040935] [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: 02/18/2023] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The association of atrial fibrillation (AF) and brain perfusion (BP) has not been well-defined. This study aimed to determine the association of persistent AF with BP and cognition, in comparison to control subjects and with regards to electrical cardioversion (ECV). METHODS This study compared 25 patients with persistent AF undergoing elective ECV with 16 age/sex-matched controls. We measured regional BP by using the magnetic resonance (MRI) arterial spin labelling technique. Cognitive function was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) cognitive function index. Measurements were performed at baseline and 6 weeks after ECV. RESULTS There was no significant difference in BP between AF patients and control subjects (p > 0.05). Following the ECV, there was a significant improvement in BP in 15 patients who maintained sinus rhythm, while there was no significant change in the recurrence group (297 ± 24 before vs. 328 ± 37 after ECV, p = 0.008, and 297 ± 22 before vs. 307 ± 24 after ECV, p = 0.45, respectively). There was no difference in the cognitive assessment between AF patients and control subjects, as well as before and after ECV within the AF group (52.2 ± 9.6 vs. 51.2 ± 6.2, p = 0.71 and 53 ± 10 vs. 54 ± 9, p = 0.46, respectively). CONCLUSIONS This study did not show difference in BP between persistent AF patients and matched control subjects. Restoration of sinus rhythm was associated with significantly improved BP. There was no association of ECV and changes in cognitive function.
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Affiliation(s)
- Josip Kedžo
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia; (J.K.)
| | - Sanja Lovrić Kojundžić
- Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia
- University Department of Health Studies, University of Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Maja Marinović Guić
- Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia
- University Department of Health Studies, University of Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Leida Tandara
- School of Medicine, University of Split, 21000 Split, Croatia
- Medical Laboratory Diagnostic Division, Medical Biochemistry and Laboratory Medicine Subdivision, University Hospital of Split, 21000 Split, Croatia
| | - Toni Brešković
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia; (J.K.)
| | - Zrinka Jurišić
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia; (J.K.)
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8
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Role of Vitamin D Deficiency in the Pathogenesis of Cardiovascular and Cerebrovascular Diseases. Nutrients 2023; 15:nu15020334. [PMID: 36678205 PMCID: PMC9864832 DOI: 10.3390/nu15020334] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Deficiency in vitamin D (VitD), a lipid-soluble vitamin and steroid hormone, affects approximately 24% to 40% of the population of the Western world. In addition to its well-documented effects on the musculoskeletal system, VitD also contributes importantly to the promotion and preservation of cardiovascular health via modulating the immune and inflammatory functions and regulating cell proliferation and migration, endothelial function, renin expression, and extracellular matrix homeostasis. This brief overview focuses on the cardiovascular and cerebrovascular effects of VitD and the cellular, molecular, and functional changes that occur in the circulatory system in VitD deficiency (VDD). It explores the links among VDD and adverse vascular remodeling, endothelial dysfunction, vascular inflammation, and increased risk for cardiovascular and cerebrovascular diseases. Improved understanding of the complex role of VDD in the pathogenesis of atherosclerotic cardiovascular diseases, stroke, and vascular cognitive impairment is crucial for all cardiologists, dietitians, and geriatricians, as VDD presents an easy target for intervention.
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Abstract
Hypertension affects a significant proportion of the adult and aging population and represents an important risk factor for vascular cognitive impairment and late-life dementia. Chronic high blood pressure continuously challenges the structural and functional integrity of the cerebral vasculature, leading to microvascular rarefaction and dysfunction, and neurovascular uncoupling that typically impairs cerebral blood supply. Hypertension disrupts blood-brain barrier integrity, promotes neuroinflammation, and may contribute to amyloid deposition and Alzheimer pathology. The mechanisms underlying these harmful effects are still a focus of investigation, but studies in animal models have provided significant molecular and cellular mechanistic insights. Remaining questions relate to whether adequate treatment of hypertension may prevent deterioration of cognitive function, the threshold for blood pressure treatment, and the most effective antihypertensive drugs. Recent advances in neurovascular biology, advanced brain imaging, and detection of subtle behavioral phenotypes have begun to provide insights into these critical issues. Importantly, a parallel analysis of these parameters in animal models and humans is feasible, making it possible to foster translational advancements. In this review, we provide a critical evaluation of the evidence available in experimental models and humans to examine the progress made and identify remaining gaps in knowledge.
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Affiliation(s)
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Daniela Carnevale
- Department of Molecular Medicine, “Sapienza” University of Rome, Italy
- Research Unit of Neuro and Cardiovascular Pathophysiology, IRCCS Neuromed, Pozzilli, Italy
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10
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Christie IN, Windsor R, Mutsaerts HJMM, Tillin T, Sudre CH, Hughes AD, Golay X, Gourine AV, Hosford PS. Cerebral perfusion in untreated, controlled, and uncontrolled hypertension. J Cereb Blood Flow Metab 2022; 42:2188-2190. [PMID: 36113055 PMCID: PMC7613835 DOI: 10.1177/0271678x221124644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 12/14/2022]
Abstract
This study evaluated the association between systemic arterial blood pressure and cerebral perfusion in 740 participants of the UK's largest tri-ethnic study with measurements of cerebral blood flow (CBF) performed using arterial spin labelling MRI. A significant negative correlation between blood pressure, age and CBF was observed across the patient cohort. The lowest CBF values were recorded in the group of patients with hypertension that were prescribed with anti-hypertensive drugs, but uncontrolled on medication. These findings confirm that hypertension is associated with reduced cerebral perfusion and highlight the importance of blood pressure control for the benefit of maintaining brain blood flow.
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Affiliation(s)
- Isabel N Christie
- Centre for Cardiovascular and Metabolic Neuroscience,
Neuroscience, Physiology and Pharmacology, University College London, London,
UK
| | - Rowan Windsor
- Centre for Cardiovascular and Metabolic Neuroscience,
Neuroscience, Physiology and Pharmacology, University College London, London,
UK
| | - Henk JMM Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, Amsterdam, The Netherlands
| | - Therese Tillin
- MRC Unit for Lifelong Health & Ageing, Population Science
& Experimental Medicine, Faculty of Population Health Sciences, University
College London, London, UK
| | - Carole H Sudre
- MRC Unit for Lifelong Health & Ageing, Population Science
& Experimental Medicine, Faculty of Population Health Sciences, University
College London, London, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, Population Science &
Experimental Medicine, Faculty of Population Health Sciences, University College
London, London, UK
| | - Xavier Golay
- Queen Square Institute of Neurology, University College London,
London, UK
| | - Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience,
Neuroscience, Physiology and Pharmacology, University College London, London,
UK
| | - Patrick S Hosford
- Centre for Cardiovascular and Metabolic Neuroscience,
Neuroscience, Physiology and Pharmacology, University College London, London,
UK
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11
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Han H, Lin Z, Soldan A, Pettigrew C, Betz JF, Oishi K, Li Y, Liu P, Albert M, Lu H. Longitudinal Changes in Global Cerebral Blood Flow in Cognitively Normal Older Adults: A Phase-Contrast MRI Study. J Magn Reson Imaging 2022; 56:1538-1545. [PMID: 35218111 PMCID: PMC9411265 DOI: 10.1002/jmri.28133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Characterization of blood supply changes in older individuals is important in understanding brain aging and diseases. However, prior studies largely focused on cross-sectional design, thus change in cerebral blood flow (CBF) could not be assessed on an individual level. PURPOSE To evaluate longitudinal short-term changes in global CBF in cognitively normal older adults. STUDY TYPE Prospective, longitudinal, and cohort. POPULATION One-hundred twenty-seven cognitive-normal participants (mean age 69 ± 7 years, 47 males) underwent serial MRI with an average follow-up time of 2.1 years. FIELD STRENGTH/SEQUENCE 3 T phase-contrast (PC), three-dimensional magnetization-prepared-rapid-acquisition-of-gradient-echo (MPRAGE) and fluid-attenuated inversion recovery (FLAIR) MRI. ASSESSMENT Total CBF was measured with PC MRI allowing assessment of quantitative flow in four major feeding arteries by a trained radiologist with >3 years' experience (O.K.). Brain volume was obtained from MPRAGE MRI and measured by T1-MultiAtlas MRICloud tool. The ratio between total CBF and brain volume yielded global CBF in mL/100 g/min. White matter hyperintensity (WMH) was measured automatically using a Bayesian probability approach on FLAIR. STATISTICAL TESTS Linear mixed effect model was used to simultaneously assess cross-sectional age-differences and longitudinal age-changes in CBF. Spearman rank correlation was used to evaluate the relationship between CBF change and WMH progression. A P-value of <0.05 (two-tailed) was considered significant. RESULTS Global CBF decreased with age at a longitudinal rate of -0.56 mL/100 g/min/year (95% confidence interval [CI]: -1.09, -0.03), compared to a cross-sectional rate of -0.26 mL/100 g/min/year (95% CI: -0.41, -0.11). Changes in CBF were significantly associated with progression of WMH (Spearman rank correlation r = -0.25), as those participants who had a more rapid CBF reduction had greater increases in WMH volumes and the relationship remained significant when adjusting for baseline vascular risk scores. Additionally, age-related changes in whole-brain volume were found to be -0.151%/year (95% CI: -0.186, -0.116). DATA CONCLUSION These findings suggest that brain aging in older adults is accompanied by a rapid longitudinal reduction in CBF, the rate of which is associated with white matter damage. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zixuan Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua F. Betz
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kumiko Oishi
- Center for Imaging Science, Johns Hopkins University, Whiting School of Engineering, Baltimore, MD, United States
| | - Yang Li
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
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12
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Whittaker JR, Steventon JJ, Venzi M, Murphy K. The Spatiotemporal Dynamics of Cerebral Autoregulation in Functional Magnetic Resonance Imaging. Front Neurosci 2022; 16:795683. [PMID: 35873811 PMCID: PMC9304653 DOI: 10.3389/fnins.2022.795683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
The thigh-cuff release (TCR) maneuver is a physiological challenge that is widely used to assess dynamic cerebral autoregulation (dCA). It is often applied in conjunction with Transcranial Doppler ultrasound (TCD), which provides temporal information of the global flow response in the brain. This established method can only yield very limited insights into the regional variability of dCA, whereas functional MRI (fMRI) has the ability to reveal the spatial distribution of flow responses in the brain with high spatial resolution. The aim of this study was to use whole-brain blood-oxygenation-level-dependent (BOLD) fMRI to characterize the spatiotemporal dynamics of the flow response to the TCR challenge, and thus pave the way toward mapping dCA in the brain. We used a data driven approach to derive a novel basis set that was then used to provide a voxel-wise estimate of the TCR associated haemodynamic response function (HRF TCR ). We found that the HRF TCR evolves with a specific spatiotemporal pattern, with gray and white matter showing an asynchronous response, which likely reflects the anatomical structure of cerebral blood supply. Thus, we propose that TCR challenge fMRI is a promising method for mapping spatial variability in dCA, which will likely prove to be clinically advantageous.
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Affiliation(s)
- Joseph R. Whittaker
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jessica J. Steventon
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Marcello Venzi
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
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13
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Robinson TG, Minhas JS, Miller J. Review of major trials of acute blood pressure management in stroke. J Cereb Blood Flow Metab 2022; 42:404-410. [PMID: 33761781 PMCID: PMC8851668 DOI: 10.1177/0271678x211004310] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/01/2021] [Accepted: 02/17/2021] [Indexed: 02/02/2023]
Abstract
Over the last two decades, there have been a number of major landmark clinical trials, classified as "major" as they sought to address clear clinical practice driven questions, in a pragmatic yet robust trial design, using a large powered sample size (n > 1000), in order to help improve patient outcome through informing guidelines. A commonality across all stroke sub-types included in these trials is the tendency to acute hypertensive crises within the acute stroke period. This phenomenon is associated with greater stroke complications and worsened overall prognosis. Multiple trials have attempted to address the issue of acute blood pressure management during the acute stroke period, with consideration for timing, magnitude of lowering, agent and relationship to other interventions. This review will consider the major clinical trials performed in ischaemic and haemorrhagic stroke that test the hypothesis that acute BP reduction improves clinical outcomes.
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Affiliation(s)
- Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester,
Leicester, UK
- National Institute for Health Research Leicester Biomedical
Research Centre, The Glenfield Hospital, Leicester, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester,
Leicester, UK
- National Institute for Health Research Leicester Biomedical
Research Centre, The Glenfield Hospital, Leicester, UK
| | - Joseph Miller
- Department of Emergency Medicine, Henry Ford Hospital and Wayne
State University, Detroit, MI, USA
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Huang CJ, Zhou X, Yuan X, Zhang W, Li MX, You MZ, Zhu XQ, Sun ZW. Contribution of Inflammation and Hypoperfusion to White Matter Hyperintensities-Related Cognitive Impairment. Front Neurol 2022; 12:786840. [PMID: 35058875 PMCID: PMC8763977 DOI: 10.3389/fneur.2021.786840] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/22/2021] [Indexed: 01/15/2023] Open
Abstract
White matter hyperintensities (WMHs) of presumed vascular origin are one of the most important neuroimaging markers of cerebral small vessel disease (CSVD), which are closely associated with cognitive impairment. The aim of this study was to elucidate the pathogenesis of WMHs from the perspective of inflammation and hypoperfusion mechanisms. A total of 65 patients with WMHs and 65 healthy controls were enrolled in this study. Inflammatory markers measurements [hypersensitive C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)], cognitive evaluation, and pseudocontinuous arterial spin labeling (PCASL) MRI scanning were performed in all the subjects. The multivariate logistic regression analysis showed that Lp-PLA2 was an independent risk factor for WMHs. Cerebral blood flow (CBF) in the whole brain, gray matter (GM), white matter (WM), left orbital medial frontal gyrus [MFG.L (orbital part)], left middle temporal gyrus (MTG.L), and right thalamus (Tha.R) in the patients was lower than those in the controls and CBF in the left triangular inferior frontal gyrus [IFG.L (triangular part)] was higher in the patients than in the controls. There was a significant correlation between Lp-PLA2 levels and CBF in the whole brain (R = -0.417, p < 0.001) and GM (R = -0.278, p = 0.025), but not in the WM in the patients. Moreover, CBF in the MFG.L (orbital part) and the Tha.R was, respectively, negatively associated with the trail making test (TMT) and the Stroop color word test (SCWT), suggesting the higher CBF, the better executive function. The CBF in the IFG.L (triangular part) was negatively correlated with attention scores in the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C) subitems (R = -0.288, p = 0.020). Our results revealed the vascular inflammation roles in WMHs, which may through the regulation of CBF in the whole brain and GM. Additionally, CBF changes in different brain regions may imply a potential role in the modulation of cognitive function in different domains.
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Affiliation(s)
- Chao-Juan Huang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xia Zhou
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Yuan
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Zhang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ming-Xu Li
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Meng-Zhe You
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao-Qun Zhu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhong-Wu Sun
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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