Cerebrovascular reactivity and cerebral autoregulation in normal subjects.
BACKGROUND
Cerebrovascular reactivity (CVR) testing with CO2 challenge is used clinically as a measure of cerebrovascular reserve. However it is not known whether CVR measures the same physiological process as spontaneous cerebral autoregulation (CA).


OBJECTIVE
To compare CVR with CA in healthy volunteers, using continuous monitoring of cerebral blood flow velocity (CBFV) and arterial blood pressure (ABP).


METHODS
We prospectively studied CVR and CA in 18 healthy volunteers. CVR was assessed using mean CBFV changes after 5% CO2 inhalation. CA was determined by transfer function analysis to derive the phase shift between spontaneous ABP and CBFV fluctuations at 0.1 Hz.


RESULTS
CO2 inhalation produced a significant decrease in phase shift from 37.9+/-13.8 degrees to 21.0+/-7.2 degrees (p<0.001). In addition, there was a significant correlation between CVR and CA changes during CO2 inhalation (R=-0.50, p=0.03), but not between CVR and baseline CA (R=0.22, p=0.4).


CONCLUSIONS
We showed a decrease in spontaneous CA after vasodilatation. However, the lack of correlation between baseline CA and degree of CVR suggests that cerebrovascular reserve and CA are based in part on distinct physiological mechanisms. Further studies are needed to determine which of these parameters is most useful to guide treatment decisions in pathological states.
Carrera
Emmanuel
E
Division of Stroke, Department of Neurology, Columbia Presbyterian Medical Center, New York, NY, USA.
Lee
Leslie K
LK
Giannopoulos
Sotirios
S
Marshall
Randolph S
RS
D000328:Adult; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001795:Blood Pressure Determination; D001921:Brain / Q000098:blood supply* / Q000502:physiology*; D002245:Carbon Dioxide / Q000378:metabolism; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D014664:Vasodilation / Q000502:physiology
D002245:Carbon Dioxide