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Lack of linear correlation between dynamic and steady‐state cerebral autoregulation
Author(s) -
Jong Daan L. K.,
Tarumi Takashi,
Liu Jie,
Zhang Rong,
Claassen Jurgen A. H. R.
Publication year - 2017
Publication title -
the journal of physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.802
H-Index - 240
eISSN - 1469-7793
pISSN - 0022-3751
DOI - 10.1113/jp274304
Subject(s) - autoregulation , middle cerebral artery , cerebral autoregulation , cerebral blood flow , medicine , cardiology , blood pressure , linear regression , anesthesia , mathematics , statistics , ischemia
Key points For correct application and interpretation of cerebral autoregulation (CA) measurements in research and in clinical care, it is essential to understand differences and similarities between dynamic and steady‐state CA. The present study found no correlation between dynamic and steady‐state CA indices in healthy older adults. There was variability between individuals in all (steady‐state and dynamic) autoregulatory indices, ranging from low (almost absent) to highly efficient CA in this healthy population. These findings challenge the assumption that assessment of a single CA parameter or a single set of parameters can be generalized to overall CA functioning. Therefore, depending on specific research purposes, the choice for either steady‐state or dynamic measures or both should be weighed carefully.Abstract The present study aimed to investigate the relationship between dynamic (dCA) and steady‐state cerebral autoregulation (sCA). In 28 healthy older adults, sCA was quantified by a linear regression slope of proportionate (%) changes in cerebrovascular resistance (CVR) in response to proportionate (%) changes in mean blood pressure (BP) induced by stepwise sodium nitroprusside (SNP) and phenylephrine (PhE) infusion. Cerebral blood flow (CBF) was measured at the internal carotid artery (ICA) and vertebral artery (VA) and CBF velocity at the middle cerebral artery (MCA). With CVR = BP/CBF, Slope‐CVR ICA , Slope‐CVR VA and Slope‐CVRi MCA were derived. dCA was assessed (i) in supine rest, analysed with transfer function analysis (gain and phase) and autoregulatory index (ARI) fit from spontaneous oscillations (ARI Baseline ), and (ii) with transient changes in BP using a bolus injection of SNP (ARI SNP ) and PhE (ARI PhE ). Comparison of sCA and dCA parameters (using Pearson's r for continuous and Spearman's ρ for ordinal parameters) demonstrated a lack of linear correlations between sCA and dCA measures. However, comparisons of parameters within dCA and within sCA were correlated. For sCA slope‐CVR VA with Slope‐CVRi MCA ( r = 0.45, P < 0.03); for dCA ARI SNP with ARI PhE (ρ = 0.50, P = 0.03), ARI Baseline (ρ = 0.57, P = 0.03) and Phase LF (ρ = 0.48, P = 0.03); and for Gain VLF with Gain LF ( r = 0.51, P = 0.01). By contrast to the commonly held assumption based on an earlier study, there were no linear correlations between sCA and dCA. As an additional observation, there was strong inter‐individual variability, both in dCA and sCA, in this healthy group of elderly, in a range from low to high CA efficiency.