Cerebrovascular Reactivity and Reserve Capacity in Type II Diabetes Mellitus

Fülesdi, Béla; Limburg, M.; Bereczki, Dániel; Káplár, Miklós; Molnár, Csilla; Kappelmayer, János; Neuwirth, G.; Csiba, László

doi:10.1016/s1056-8727(99)00044-6

Cited by 68 publications

(54 citation statements)

References 39 publications

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“…Cerebral microvascular disease in diabetes has been attributed to the effects of chronic hyperglycemia on capillary structure (2), endothelial reactivity (3), and blood-brain barrier permeability, thus affecting regional metabolism and blood flow regulation (4). Xenon blood flow (5) and transcranial Doppler ultrasound (TCD) studies indicate that patients with type 2 diabetes have impaired cerebrovascular reactivity to hypercapnia (6,7). Subcortical white matter hyperintensities (WMHs), which are seen as multifocal and diffuse areas of hyperintensity on T2-weighted magnetic resonance imaging (MRI) (8), are strongly associated with diabetes, hypertension, and other cardiovascular risk factors (9,10).…”

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confidence: 99%

Cerebral Blood Flow Velocity and Periventricular White Matter Hyperintensities in Type 2 Diabetes

Novak

Alsop²,

Abduljalil³

et al. 2006

Diabetes Care

147

101

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OBJECTIVE -Diabetes increases the risk for cerebromicrovascular disease, possibly through its effects on blood flow regulation. The aim of this study was to assess the effects of type 2 diabetes on blood flow velocities (BFVs) in the middle cerebral arteries and to determine the relationship between white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) and BFVs.RESEARCH DESIGN AND METHODS -We measured BFVs in 28 type 2 diabetic and 22 control subjects (aged 62.3 Ϯ 7.2 years) using transcranial Doppler ultrasound during baseline, hyperventilation, and CO 2 rebreathing. WMHs were graded, and their volume was quantified from fluid-attenuated inversion recovery images on a 3.0 Tesla MRI.RESULTS -The diabetic group demonstrated decreased mean BFVs and increased cerebrovascular resistance during baseline, hypo-and hypercapnia (P Ͻ 0.0001), and impaired CO 2 reactivity (P ϭ 0.05). WMH volume was negatively correlated with baseline BFV (P Ͻ 0.0001). A regression model revealed that baseline BFVs were negatively associated with periventricular WMHs, HbA 1c (A1C), and inflammatory markers and positively associated with systolic blood pressure (R 2 ϭ 0.86, P Ͻ 0.0001).CONCLUSIONS -Microvascular disease in type 2 diabetes, which manifests as white matter abnormalities on MRI, is associated with reduced cerebral BFVs, increased resistance in middle cerebral arteries, and inflammation. These findings are clinically relevant as a potential mechanism for cerebrovascular disease in elderly with type 2 diabetes.

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confidence: 99%

Cerebral Blood Flow Velocity and Periventricular White Matter Hyperintensities in Type 2 Diabetes

Novak

Alsop²,

Abduljalil³

et al. 2006

Diabetes Care

147

101

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“…Previous data are conflicting in this respect. Keymeulen et al could prove this association in T1DM patients (10), whereas Fülesdi et al did not find a correlation between these parameters either in T1DM or in T2DM patients (5,6). The reduction in CBF is probably due to the continuously elevated glucose level through years; in contrast, a change in HbA1c level is seen an average of only 8-10 wk before blood sampling.…”

Section: Discussionmentioning

confidence: 97%

“…B-mode ultrasound can be useful in the examination of large and medium arteries, whereas SPECT, MRI, and transcranial Doppler are able to recognize disturbances of the microcirculation. Previous studies using Doppler ultrasound found decreased reactivity and reserve capacity of large and medium arteries in both types of diabetes (4)(5)(6). Fülesdi et al found that the decrease in circulation became pronounced 10 y after the diagnosis of both types of diabetes (5,6).…”

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confidence: 97%

“…Previous studies using Doppler ultrasound found decreased reactivity and reserve capacity of large and medium arteries in both types of diabetes (4)(5)(6). Fülesdi et al found that the decrease in circulation became pronounced 10 y after the diagnosis of both types of diabetes (5,6). Other studies used the SPECT method to measure semiquantitatively the CBF and reserve capacity and found a significant decrease in both parameters (7)(8)(9).…”

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confidence: 99%

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Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Káplár¹,

Paragh²,

Erdei³

et al. 2009

J Nucl Med

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Although macrovascular complications are typical for type 2 diabetes mellitus (T2DM), cerebral microvascular damage develops both in type 1 diabetes mellitus (T1DM) and T2DM. Color Doppler ultrasound is widely used for the examination of large-and medium-sized arteries, whereas SPECT and MRI are capable of identifying disturbances in the circulation of microvessels. Former studies using semiquantitative methods showed reduced reactivity and reserve capacity of cerebral vessels in both T1DM and T2DM patients. Our aim was to investigate whether there was any difference in the effects of the 2 types of diabetes mellitus on the global or regional cerebral blood flow, influenced by microvascular damage. Methods: In our study, the circulation and reserve capacity of cerebral arteries was examined using 99m Tc-hexamethylpropylene amine oxime SPECT. A total of 17 individuals with T1DM and 43 individuals with T2DM were involved in the study. Results: Both basal and acetazolamide-challenged brain circulation were significantly lower in T2DM patients than in T1DM patients. We did not find a significant difference in the reserve capacity. However, the circulation of the frontal and occipital lobes changed differently in the 2 groups. The ratio of the circulation of the frontal and occipital lobes was significantly reduced both in basal and in acetazolamide-stimulated states in T2DM patients, independently of age (P , 0.0005 and P , 0.017), showing a greater relative decrease in the circulation of the frontal lobe in T2DM patients. Conclusion: There was a significant association between basal brain circulation and age, body mass index, and high-density lipoprotein (HDL), whereas acetazolamide-stimulated circulation showed a significant association with serum triglyceride and HDL.Key Words: diabetes mellitus; cerebral perfusion; SPECT; reserve capacity; frontooccipital ratio Nucl Med 2009; 50:1993 50: -1998 50: DOI: 10.2967 Di abetes mellitus considerably increases the risk of stroke due to the damage of cerebral arteries (1,2). Macrovascular complications are typical for type 2 diabetes mellitus (T2DM); however, the injury of cerebral microvessels can be detected in both type 1 diabetes mellitus (T1DM) and T2DM. Hyperglycemia leads to structural damage of capillaries and endothelial dysfunction, and the permeability of the blood-brain barrier is also altered in diabetics (3). These factors significantly affect the regional and global cerebral blood flow (CBF) and the metabolism of the brain. The damage of the vessels can be demonstrated even before the appearance of clinical symptoms. B-mode ultrasound can be useful in the examination of large and medium arteries, whereas SPECT, MRI, and transcranial Doppler are able to recognize disturbances of the microcirculation. Previous studies using Doppler ultrasound found decreased reactivity and reserve capacity of large and medium arteries in both types of diabetes (4-6). Fülesdi et al. found that the decrease in circulation became pronounced 10 y after the diagnosis of both typ...

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“…No recommendations were made for secondary stroke prevention except for the exclusion of lipidlowering treatment. Because uncontrolled hypertension and diabetes decreased CVR, 13,14 all patients were seen by 1 neurologist (P.L.) at Bichat Hospital 1 month after the stroke event (M-2 visit).…”

Section: Methodsmentioning

confidence: 99%

Placebo-Controlled Trial of High-Dose Atorvastatin in Patients With Severe Cerebral Small Vessel Disease

Lavallée

Labreuche

Góngora‐Rivera

et al. 2009

Stroke

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patients with mild small vessel disease. We sought to determine whether high-dose atorvastatin increases CVR compared with placebo in patients with severe small vessel disease. Methods-Ninety-four adults with recent lacunar stroke were randomly allocated in a double-blind manner to 80 mg of atorvastatin daily or matching placebo after stratification for hypertensive and diabetic status. The primary end point was change in CVR after 3 months of treatment. Secondary outcomes were changes in brachial and carotid artery endothelial-dependent vasodilations. Results-At baseline, all patients had a severely impaired CVR (mean, 12.1%; 95% CI, 9.5-14.7) and carotid (mean, Ϫ0.25%; 95% CI, Ϫ1.17-0.67) and brachial artery (mean, 2.72%; 95% CI, 1.39 -4.05) endothelial function. Despite reductions of 55% in low-density lipoprotein cholesterol and of 30% in high-sensitivity C-reactive protein in the active arm compared to placebo, atorvastatin 80 mg per day did not improve CVR or endothelial dysfunction of carotid and brachial arteries. Conclusion-We

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Cerebrovascular Reactivity and Reserve Capacity in Type II Diabetes Mellitus

Cited by 68 publications

References 39 publications

Cerebral Blood Flow Velocity and Periventricular White Matter Hyperintensities in Type 2 Diabetes

Cerebral Blood Flow Velocity and Periventricular White Matter Hyperintensities in Type 2 Diabetes

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Placebo-Controlled Trial of High-Dose Atorvastatin in Patients With Severe Cerebral Small Vessel Disease

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