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Journal of Clinical Monitoring and Computing
Published in: Journal of Clinical Monitoring and Computing 1/2019

01-02-2019 | Original Research

Assessment of cerebral hemodynamic parameters using pulsatile versus non-pulsatile cerebral blood outflow models

Authors: Agnieszka Uryga, Magdalena Kasprowicz, Leanne Calviello, Rolf R. Diehl, Katarzyna Kaczmarska, Marek Czosnyka

Published in: Journal of Clinical Monitoring and Computing | Issue 1/2019

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Abstract

Background

Prior methods evaluating the changes in cerebral arterial blood volume (∆CaBV) assumed that brain blood transport distal to big cerebral arteries can be approximated with a non-pulsatile flow (CFF) model. In this study, a modified ∆CaBV calculation that accounts for pulsatile blood flow forward (PFF) from large cerebral arteries to resistive arterioles was investigated. The aim was to assess cerebral hemodynamic indices estimated by both CFF and PFF models while changing arterial blood carbon dioxide concentration (EtCO2) in healthy volunteers.

Materials and methods

Continuous recordings of non-invasive arterial blood pressure (ABP), transcranial Doppler blood flow velocity (CBFVa), and EtCO2 were performed in 53 young volunteers at baseline and during both hypo- and hypercapnia. The time constant of the cerebral arterial bed (τ) and critical closing pressure (CrCP) were estimated using mathematical transformations of the pulse waveforms of ABP and CBFVa, and with both pulsatile and non-pulsatile models of ∆CaBV estimation. Results are presented as median values ± interquartile range.

Results

Both CrCP and τ gave significantly lower values with the PFF model when compared with the CFF model (p ≪ 0.001 for both). In comparison to normocapnia, both CrCP and τ determined with the PFF model increased during hypocapnia [CrCPPFF (mm Hg): 5.52 ± 8.78 vs. 14.36 ± 14.47, p = 0.00006; τPFF (ms): 47.4 ± 53.9 vs. 72.8 ± 45.7, p = 0.002] and decreased during hypercapnia [CrCPPFF (mm Hg): 5.52 ± 8.78 vs. 2.36 ± 7.05, p = 0.0001; τPFF (ms): 47.4 ± 53.9 vs. 29.0 ± 31.3, p = 0.0003]. When the CFF model was applied, no changes were found for CrCP during hypercapnia or in τ during hypocapnia.

Conclusion

Our results suggest that the pulsatile flow forward model better reflects changes in CrCP and in τ induced by controlled alterations in EtCO2.
Literature
1.
Avezaat CJJ, van Eijndhoven JHM. The role of the pulsatile pressure variations in intracranial pressure monitoring. Neurosurg Rev. 1986;9:113–20.CrossRefPubMed
2.
Alperin N, Sivaramakrishnan A, Lichtor T. Magnetic resonance imaging-based measurements of cerebrospinal fluid and blood flow as indicators of intracranial compliance in patients with Chiari malformation. J Neurosurg. 2005;103:46–52.CrossRefPubMed
3.
Stoquart-Elsankari S, Lehmann P, Villette A, Czosnyka M, Meyer M-E, Deramond H, et al. A phase-contrast MRI study of physiologic cerebral venous flow. J Cereb Blood Flow Metab. 2009;29:1208–15.CrossRefPubMed
4.
Kim DJ, Kasprowicz M, Carrera E, Castellani G, Zweifel C, Lavinio A, et al. The monitoring of relative changes in compartmental compliances of brain. Physiol Meas. 2009;30:647–59.CrossRefPubMed
5.
Carrera E, Kim DJ, Castellani G, Zweifel C, Smielewski P, Pickard JD, et al. Effect of hyper- and hypocapnia on cerebral arterial compliance in normal subjects. J Neuroimaging. 2011;21:121–5.CrossRefPubMed
6.
Nasr N, Czosnyka M, Pavy-Le Traon A, Custaud M-A, Liu X, Varsos GV, et al. Baroreflex and cerebral autoregulation are inversely correlated. Circ J. 2014;78:2460–7.CrossRefPubMed
7.
Czosnyka M, Richards HK, Reinhard M, Steiner L, Budohoski K, Smielewski P, et al. Cerebrovascular time constant: dependence on cerebral perfusion pressure and end-tidal carbon dioxide concentration. Neurol Res. 2012;34:17–24.CrossRefPubMed
8.
Kasprowicz M, Diedler J, Reinhard M, Carrera E, Steiner LA, Smielewski P, et al. Time constant of the cerebral arterial bed in normal subjects. Ultrasound Med Biol. 2012;38:1129–37.CrossRefPubMed
9.
Kasprowicz M, Diedler J, Reinhard M, Carrera E, Smielewski P, Budohoski KP, et al. Time constant of the cerebral arterial bed. Acta Neurochir Suppl. 2012;114:17–21.CrossRefPubMed
10.
Varsos GV, Richards H, Kasprowicz M, Budohoski KP, Brady KM, Reinhard M, et al. Critical closing pressure determined with a model of cerebrovascular impedance. J Cereb Blood Flow Metab. 2013;33:235–43.CrossRefPubMed
11.
Kasprowicz M, Czosnyka M, Soehle M, Smielewski P, Kirkpatrick PJ, Pickard JD, et al. Vasospasm shortens cerebral arterial time constant. Neurocrit Care. 2012;16:213–8.CrossRefPubMed
12.
Carrera E, Kim D-J, Castellani G, Zweifel C, Smielewski P, Pickard JD, et al. Cerebral arterial compliance in patients with internal carotid artery disease. Eur J Neurol. 2011;18:711–8.CrossRefPubMed
13.
Varsos GV, Budohoski KP, Czosnyka M, Kolias AG, Nasr N, Donnelly J, et al. Cerebral vasospasm affects arterial critical closing pressure. J Cereb Blood Flow Metab. 2015;35:285–91.CrossRefPubMed
14.
Varsos GV, Kolias AG, Smielewski P, Brady KM, Varsos VG, Hutchinson PJ, et al. A noninvasive estimation of cerebral perfusion pressure using critical closing pressure. J Neurosurg. 2015;123:638–48.CrossRefPubMed
15.
Carrera E, Kim D-J, Castellani G, Zweifel C, Czosnyka Z, Kasprowicz M, et al. What shapes pulse amplitude of intracranial pressure? J Neurotrauma. 2010;27:317–24.CrossRefPubMed
16.
Ambarki K, Baledent O, Kongolo G, Bouzerar R, Fall S, Meyer ME. A new lumped-parameter model of cerebrospinal hydrodynamics during the cardiac cycle in healthy volunteers. IEEE Trans Biomed Eng. 2007;54:483–91.CrossRefPubMed
17.
Czosnyka M, Smielewski P, Kirkpatrick P, Piechnik S, Laing R, Pickard JD. Continuous monitoring of cerebrovascular pressure-reactivity in head injury. Acta Neurochir Suppl. 1998;71:74–7.PubMed
18.
Czosnyka M, Guazzo E, Whitehouse M, Smielewski P, Czosnyka Z, Kirkpatrick P, et al. Significance of intracranial pressure waveform analysis after head injury. Acta Neurochir. 1996;138:531–42.CrossRefPubMed
19.
Poulin MJ, Robbins PA. Indexes of flow and cross-sectional area of the middle cerebral artery using doppler ultrasound during hypoxia and hypercapnia in humans. Stroke. 1996;27:2244–50.CrossRefPubMed
20.
Valdueza JM, Balzer JO, Villringer A, Vogl TJ, Kutter R, Einhäupl KM. Changes in blood flow velocity and diameter of the middle cerebral artery during hyperventilation: assessment with MR and transcranial Doppler sonography. Am J Neuroradiol. 1997;18:1929–34.PubMed
21.
Henriksen JH, Fuglsang S, Bendtsen F, Christensen E, Møller S. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index. Am J Physiol Gastrointest Liver Physiol. 2001;280:G584–94.CrossRefPubMed
22.
Panerai RB, Salinet ASM, Brodie FG, Robinson TG. The influence of calculation method on estimates of cerebral critical closing pressure. Physiol Meas. 2011;32:467–82.CrossRefPubMed
23.
Altman BjM. DG. Statistics notes: calculating correlation coefficients with repeated observations: part 1-correlation within subjects. BMJ. 1995;310:446.CrossRefPubMedPubMedCentral
24.
25.
Varsos GV, Kasprowicz M, Smielewski P, Czosnyka M. Model-based indices describing cerebrovascular dynamics. Neurocrit Care. 2014;20:142–57.CrossRefPubMed
26.
Brothers RM, Zhang R. CrossTalk opposing view: the middle cerebral artery diameter does not change during alterations in arterial blood gases and blood pressure. J Physiol. 2016;594:4077–9.CrossRefPubMedPubMedCentral
27.
Hoiland RL, Ainslie PN. CrossTalk proposal: The middle cerebral artery diameter does change during alterations in arterial blood gases and blood pressure. J Physiol. 2016;594:4073–5.CrossRefPubMedPubMedCentral
28.
Djurberg HG, Seed RF, Price Evans DA, Brohi FA, Pyper DL, Tjan GT, et al. Lack of effect of CO2 on cerebral arterial diameter in man. J Clin Anesth. 1998;10:646–51.CrossRefPubMed
29.
Serrador JM, Picot P, Rutt BK, Shoemaker JK, Bondar RL. MRI measures of middle cerebral artery diameter in conscious humans during simulated orthostasis. Stroke. 2000;31:1672–8.CrossRefPubMed
30.
Schreiber SJ, Gottschalk S, Weih M, Villringer A, Valdueza JM. Assessment of blood flow velocity and diameter of the middle cerebral artery during the acetazolamide provocation test by use of transcranial Doppler sonography and MR imaging. AJNR Am J Neuroradiol. 2000;21:1207–11.PubMed
31.
Verbree J, Bronzwaer A-SGT, Ghariq E, Versluis MJ, Daemen MJAP., van Buchem MA, et al. Assessment of middle cerebral artery diameter during hypocapnia and hypercapnia in humans using ultra-high-field MRI. J Appl Physiol. 2014;117:1084–9.CrossRefPubMed
32.
Coverdale NS, Lalande S, Perrotta A, Shoemaker JK. Heterogeneous patterns of vasoreactivity in the middle cerebral and internal carotid arteries. Am J Physiol- Hear Circ Physiol. 2015;308:H1030–8.CrossRef
33.
Kim S-G, Harel N, Jin T, Kim T, Lee P, Zhao F. Cerebral blood volume MRI with intravascular superparamagnetic iron oxide nanoparticles. NMR Biomed. 2013;26:949–62.CrossRefPubMed
Metadata
Title
Assessment of cerebral hemodynamic parameters using pulsatile versus non-pulsatile cerebral blood outflow models
Authors
Agnieszka Uryga
Magdalena Kasprowicz
Leanne Calviello
Rolf R. Diehl
Katarzyna Kaczmarska
Marek Czosnyka
Publication date
01-02-2019
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 1/2019
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-018-0136-1

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