Severity of Coronary Artery Disease but Not Degree of Coronary Stenosis Is Correlated to Cerebrovascular Reactivity

Rosengarten, Bernhard; Grebe, Mathias; Müller, Andreas; Voß, Rainer; Kaps, Manfred

doi:10.1159/000228712

Cited by 8 publications

(6 citation statements)

References 42 publications

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“…Our fTCD findings are therefore indicative of a disturbed neurovascular coupling in the visual cortex of FD patients. The decreased rate time and gain reflect a lower hemodynamic response to visual activation tasks [25,26]. As data from animal experiments suggest that this response might be related to a deficit in the nitric oxide system [27], our results fit into the hypothesis of an impaired functioning of the endothelial nitric oxide system in FD [28].…”

Section: Discussionsupporting

confidence: 71%

Functional Transcranial Doppler: Presymptomatic Changes in Fabry Disease

Azevedo

Mendes²,

Seixas³

et al. 2012

Eur Neurol

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Background and Aim: Cerebrovascular disease may progress asymptomatically in the early stages of Fabry disease (FD). Our aim was to test whether functional transcranial Doppler (fTCD) could provide useful data in the evaluation of these presymptomatic FD patients. Methods: A cohort of 12 adult FD patients from families with the classical phenotype of the disease was evaluated with fTCD in the posterior cerebral artery. Results: Compared to healthy controls, resting blood velocities were significantly lower in the FD cohort (p = 0.032 for systolic, p = 0.021 for diastolic). FTCD suggested a disturbed neurovascular coupling in the visual cortex of FD patients, with lower gain (p = 0.007) and rate time (p = 0.019). Men had a significantly higher attenuation (p = 0.013) and lower natural frequency (p = 0.046) than the heterozygous women. Conclusion: These data are the first to suggest that patients with FD may develop cortical vascular dysfunction in the territory of the posterior circulation, early in the natural history of the disease. If the present findings are confirmed in larger, prospective studies, fTCD will be useful for assessing stroke risk in as yet asymptomatic FD patients, improving preventive therapeutic management.

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Section: Discussionsupporting

confidence: 71%

Functional Transcranial Doppler: Presymptomatic Changes in Fabry Disease

Azevedo

Mendes²,

Seixas³

et al. 2012

Eur Neurol

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“…The association between altered cerebrovascular reactivity and the degree of coronary atherosclerosis has been found [ 41 ] and it was confirmed also in patients without carotid stenosis [ 14 ], so the link between CAD and cerebrovascular functional impairment has been supported.…”

Section: Discussionmentioning

confidence: 90%

Young smoker “ABCD” vascular assessment: a four-step ultrasound examination for detecting peripheral, extra and intra-cranial early arterial damage

Mozzini

Casadei²,

Roscia

et al. 2016

BMC Cardiovasc Disord

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BackgroundCigarette smoking is known as a major risk factor in the pathogenic mechanisms of stroke, coronary and peripheral artery disease (CAD and PAD), even in young subjects. The aim of this study is the creation of a four-step ultrasound examination to evaluate and monitor the peripheral, the extra and the intra-cranial assessment of the arterial early damage in smokers. The evaluations of A, the Ankle-brachial index, ABI, B, the Breath holding index, BHI, C, the Carotid intima media thickness, CIMT, and D, the Diameter of the abdominal aorta represent the “ABCD” assessment.MethodsThirty-eight healthy smokers and 43 controls underwent A, calculated for each leg. B was calculated after determination of subjects’ flow velocity of middle cerebral artery (MCA) by trans-cranial colour Doppler (TCCD) before and after 30 s of apnoea at baseline and just after smoking a cigarette, to simulate the chronic and acute effects of smoking. Finally, C and D evaluation were assessed using a high-resolution B-mode ultrasound.ResultsSmokers presented higher values of CIMT (mean and maximal), and lower BHI both at baseline and just after smoking (p < 0.01), though in the normal range. No significant differences were found for A and D between smokers and non- smokers.ConclusionsOur results underline the importance of the assessment of B and C, that, though in the normal range, present significant differences between smokers and non-smokers. These data could drive the screening between smokers in age-related manner. Moreover, the “ABCD” examination could represent a valid method to detect and then monitor smokers’ vascular damage. Although it is far to be considered a screening and routine tool, it should be contemplated in a wider context of possible not-invasive practical screening and follow-up modalities. This would be designed to implement preventive strategies and tools aimed at discouraging tobacco addiction and monitoring cardiovascular risk patients.

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“…Each patient in the deteriorating group had a history of coronary artery disease, whereas in the recovery group, this was only in 29% of cases. It is known that the severity of the coronary artery disease is correlated with a decreased gain parameter [30]. However, patients with previous vascular diseases are known to be more prone to a more severe sepsis syndrome and worse outcome [1-3].…”

Section: Discussionmentioning

confidence: 99%

Early neurovascular uncoupling in the brain during community acquired pneumonia

et al. 2012

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IntroductionSepsis leads to microcirculatory dysfunction and therefore a disturbed neurovascular coupling in the brain. To investigate if the dysfunction is also present in less severe inflammatory diseases we studied the neurovascular coupling in patients suffering from community acquired pneumonia.MethodsPatients were investigated in the acute phase of pneumonia and after recovery. The neurovascular coupling was investigated with a simultaneous electroencephalogram (EEG)-Doppler technique applying a visual stimulation paradigm. Resting EEG frequencies, visual evoked potentials as well as resting and stimulated hemodynamic responses were obtained. Disease severity was characterized by laboratory and cognitive parameters as well as related scoring systems. Data were compared to a control group.ResultsWhereas visually evoked potentials (VEP) remained stable a significant slowing and therefore uncoupling of the hemodynamic responses were found in the acute phase of pneumonia (Rate time: control group: 3.6 ± 2.5 vs. acute pneumonia: 1.6 ± 2.4 s; P < 0.0005). In the initial investigation, patients who deteriorated showed a decreased hemodynamic response as compared with those who recovered (gain: recovered: 15% ± 4% vs. deteriorated: 9% ± 3%, P < 0.05; control: 14% ± 5%). After recovery the coupling normalized.ConclusionsOur study underlines the role of an early microcirculatory dysfunction in inflammatory syndromes that become evident in pre-septic conditions with a gradual decline according to disease severity.

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Severity of Coronary Artery Disease but Not Degree of Coronary Stenosis Is Correlated to Cerebrovascular Reactivity

Cited by 8 publications

References 42 publications

Functional Transcranial Doppler: Presymptomatic Changes in Fabry Disease

Functional Transcranial Doppler: Presymptomatic Changes in Fabry Disease

Young smoker “ABCD” vascular assessment: a four-step ultrasound examination for detecting peripheral, extra and intra-cranial early arterial damage

Early neurovascular uncoupling in the brain during community acquired pneumonia

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