Cerebral blood flow autoregulation in ischemic heart failure

Caldas, Juliana; Panerai, Ronney B.; Haunton, Victoria J.; Almeida, Juliano Pinheiro de; Ferreira, Gerson Moura; Câmara, Lígia; Nogueira, Ricardo de Carvalho; Bor‐Seng‐Shu, Edson; Oliveira, Marcelo L.; Groehs, Raphaela R. V.; Ferreira‐Santos, Larissa; Teixeira, Manoel Jacobsen; Galas, Filomena Regina Barbosa Gomes; Robinson, Thompson G.; Jatene, Fábio Biscegli; Hajjar, Ludhmila Abrahão

doi:10.1152/ajpregu.00361.2016

Cited by 65 publications

(50 citation statements)

References 40 publications

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“…In a longitudinal nondemented population-based study with echocardiography assessments at baseline and after five years follow up, van den Hurk et al concluded that cognitive decline can be observed in the early stages of left ventricular dysfunction and heart failure 11 . It seems that from the above-mentioned mechanisms, impaired cerebrovascular autoregulation and endothelial dysfunction are possibly more affected with even mild reduction of the ejection fraction 24 . Our patients were selected from referrals to a cardiac catheterization unit.…”

Section: Discussionmentioning

confidence: 99%

Association between cognitive function and parameters of echocardiography and coronary artery angiography

Hashemi

Jervekani

Mortazavi

et al. 2018

Arq. Neuro-Psiquiatr.

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We aimed to determine whether there is an association between cognition and the results of echocardiography and angiography, based on neuropsychological assessments. Methods: We assessed the cognition of 85 patients who had recently undergone coronary artery angiography. We calculated the Gensini score for the coronary artery disease index. We also performed echocardiography to find indices of cardiac functioning. Results: The lower left ventricular ejection fraction correlated with lower scores on visuospatial, executive function, processing speed/attention and verbal memory capacities (p ≤ 0.05). A higher Gensini score and left atrial size correlated with lower executive function and processing speed/attention (p ≤ 0.05). In the group of patients with an impaired cognitive state, higher Gensini scores correlated with decreased processing speed/attention (p = 0.01) and the e' index was associated with lower capacity of executive function (p = 0.05). Conclusion: Decreased processing speed/attention and executive function may correlate with cardiac dysfunction and coronary artery disease. The Color Trail Test may be considered for simple screening for cognitive problems in elderly patients with coronary artery disease or diastolic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Association between cognitive function and parameters of echocardiography and coronary artery angiography

Hashemi

Jervekani

Mortazavi

et al. 2018

Arq. Neuro-Psiquiatr.

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“…In general, a brachial mean BP ≥60 mm Hg is thought to afford an adequate cerebral blood flow. Cerebral blood flow autoregulation may be affected in advanced age,49 by endotheliopathy, hypertension, diabetes mellitus,50 heart failure,51 hypocapnia, alkalosis, sympathetic arousal, autonomic failure,52 early after head injury, during an acute ischaemic stroke or during sepsis 53. The cerebral flow reserve also depends on the existence of cerebral small and large artery disease.…”

Section: Bp Goalsmentioning

confidence: 99%

Blood pressure management in older people: balancing the risks

Naschitz

2018

Postgraduate Medical Journal

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Guidelines of arterial hypertension treatment based on individualised expected outcomes are not available for frail older persons. In this paper, we review the evidence, concerning management of arterial blood pressure (BP) in frail older patients. We focused on the best affordable methods for BP measurement; the age-related optimum BP; specific BP goals in agreement with the patients' general heath, frailty status, orthostatic and postprandial hypotension; balancing the benefits against risks of antihypertensive treatment. Lenient BP goals are generally recommended for older persons with moderate or severe frailty, multimorbidity and limited life expectancy. To this aim, there may be a need for deintensification of antihypertensive treatment.

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“…In a healthy cardiovascular system, cerebral flow rate changes slightly within a range between 60 and 140 mm Hg of arterial blood pressure . However, in the heart failure patients' clinical data indicates that cerebral flow autoregulation function may be impaired and there might be a mild to moderate average cerebral flow rate reduction . Moreover, cerebral flow may reduce by up to 30 percent although arterial blood pressure remains within the autoregulation zone .…”

mentioning

confidence: 99%

Effect of Cerebral Flow Autoregulation Function on Cerebral Flow Rate Under Continuous Flow Left Ventricular Assist Device Support

Bozkurt

2018

Artificial Organs

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Neurological complications in continuous flow left ventricular assist device (CF-LVAD) patients are the second-leading risk of death after multi-organ failure. They are associated with altered blood flow in the cardiovascular system because of CF-LVAD support. Moreover, an impaired cerebral autoregulation function may also contribute to complications such as hyperperfusion in the cerebral circulation under mechanical circulatory support. The aim of this study is to evaluate the effect of cerebral autoregulatory function on cerebral blood flow rate under CF-LVAD support. A lumped parameter model was used to simulate the cardiovascular system including the heart chambers, heart valves, systemic and pulmonary circulations and cerebral circulation which includes entire Circle of Willis. A baroreflex model was used to regulate the systemic arteriolar and cerebral vascular resistances and a model of the Micromed CF-LVAD was used to simulate the pump dynamics at different operating speeds. Additionally, preserved and impaired cerebral autoregulatory functions were simulated in heart failure and under CF-LVAD support. Cerebral blood flow rate was restored under CF-LVAD support at 10 500 rpm pump operating speed which generated a similar arterial blood pressure and blood flow as in a healthy condition for the impaired cerebral autoregulatory function while the preserved cerebral autoregulatory function regulated the cerebral flow rate within a relatively low range for the applied pump operating speeds. Relatively low or high pump operating speeds may cause underpefusion or hyperperfusion for a failing cardiovascular system with impaired cerebral autoregulatory function under CF-LVAD support which will contribute to the worsening of cerebral complications.

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Cerebral blood flow autoregulation in ischemic heart failure

Cited by 65 publications

References 40 publications

Association between cognitive function and parameters of echocardiography and coronary artery angiography

Association between cognitive function and parameters of echocardiography and coronary artery angiography

Blood pressure management in older people: balancing the risks

Effect of Cerebral Flow Autoregulation Function on Cerebral Flow Rate Under Continuous Flow Left Ventricular Assist Device Support

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