Cerebral critical closing pressure and resistance-area product: the influence of dynamic cerebral autoregulation, age and sex

Author:

Panerai Ronney B12ORCID,Haunton Victoria J12,Llwyd Osian1ORCID,Minhas Jatinder S12,Katsogridakis Emmanuel3,Salinet Angela SM4ORCID,Maggio Paola5,Robinson Thompson G12

Affiliation:

1. Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

2. NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK

3. Department of Vascular Surgery, Wythenshawe Hospital, Manchester Foundation Trust, Manchester, UK

4. Neurology Department, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

5. Neurology Department, ASST Bergamo EST (BG), Italy

Abstract

Instantaneous arterial pressure-flow (or velocity) relationships indicate the existence of a cerebral critical closing pressure (CrCP), with the slope of the relationship expressed by the resistance-area product (RAP). In 194 healthy subjects (20–82 years, 90 female), cerebral blood flow velocity (CBFV, transcranial Doppler), arterial blood pressure (BP, Finapres) and end-tidal CO2 (EtCO2, capnography) were measured continuously for five minutes during spontaneous fluctuations of BP at rest. The dynamic cerebral autoregulation (CA) index (ARI) was extracted with transfer function analysis from the CBFV step response to the BP input and step responses were also obtained for the BP-CrCP and BP-RAP relationships. ARI was shown to decrease with age at a rate of −0.025 units/year in men (p = 0.022), but not in women (p = 0.40). The temporal patterns of the BP-CBFV, BP-CrCP and BP-RAP step responses were strongly influenced by the ARI (p < 0.0001), but not by sex. Age was also a significant determinant of the peak of the CBFV step response and the tail of the RAP response. Whilst the RAP step response pattern is consistent with a myogenic mechanism controlling dynamic CA, further work is needed to explore the potential association of the CrCP step response with the flow-mediated component of autoregulation.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Clinical Neurology,Neurology

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