Multi-metrics assessment of dynamic cerebral autoregulation in middle and posterior cerebral arteries in young fit women

Abstract

Individuals with low orthostatic tolerance show greater decrease in posterior cerebral artery mean blood velocity (PCAvmean). Since young fit women often experience presyncopal symptoms, their posterior cerebral circulation may be prone to greater decreases in PCAvmean, probably explained by an attenuated dynamic cerebral autoregulation (dCA). Regional differences in dCA have never been evaluated in young fit women. We compared dCA in the middle cerebral artery (MCA) and posterior cerebral artery (PCA) in 11 young fit women (25 ± 4y; ) in response to a sit-to-stand (5 min sitting followed by 5 min standing) and repeated squat-stand maneuvers performed at 0.05 Hz and 0.10 Hz. The cerebral pressure-flow relationship was characterized using four metrics: 1) percent reduction in blood velocity (BV) per percent reduction in MAP (% BV/% MAP) during initial orthostatic stress (0-15 s after sit-to-stand); 2) onset of the regulatory response (i.e. time delay before an increase in conductance (BV/MAP); 3) rate of regulation (RoR), following sit-to-stand and; 4) transfer function analysis (TFA) of forced MAP oscillations induced by repeated squat-stands. Upon standing, the relative decline in MCAvmean and PCAvmean was similar (−25 ± 9 vs. −30 ± 13%; p=0.29). The onset of the regulatory response (p=0.665), %ΔBV/%ΔMAP (p=0.129) and RoR (p=0.067) were not different between MCA and PCA. In regard to TFA, there was an ANOVA artery effect for gain (p<0.001) and a frequency effect for phase (p<0.001). These findings indicate the absence of regional differences in dCA in young fit women.New findingsWhat is the central question of this study?Are there regional differences in the dynamic cerebral autoregulation in young fit women?What is the main finding and its importance?The key finding of this study is that there are no differences in dynamic cerebral autoregulation between both arteries. These results indicate that dynamic cerebral autoregulation does not seem to be responsible for making the posterior cerebral circulation more vulnerable to transient reduction in blood pressure in young fit women.