Evaluation of impaired dynamic cerebral autoregulation by the Mueller manoeuvre
Arterial blood pressure (ABP) shows polyphasic changes during the Mueller manoeuvre (voluntary negative intrathoracic pressure). The aim of the present study was to investigate (1) whether these changes could be applied to detect impaired dynamic cerebral autoregulation (dCA) in carotid stenosis and...
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| Veröffentlicht in: | Clinical physiology (Oxford) 2001-03, Vol.21 (2), p.229-237 |
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| creator | Reinhard, Matthias Hetzel, Andreas Lauk, Michael Lücking, Carl H. |
| description | Arterial blood pressure (ABP) shows polyphasic changes during the Mueller manoeuvre (voluntary negative intrathoracic pressure). The aim of the present study was to investigate (1) whether these changes could be applied to detect impaired dynamic cerebral autoregulation (dCA) in carotid stenosis and (2) whether the degree of indicated impairment correlates with transfer function phase as another current measure for dCA (deep breathing method) and CO2‐reactivity. We examined 13 patients with severe unilateral carotid artery stenosis and 16 age‐matched controls during 15‐s Mueller manoeuvres (MM) at −30 mmHg using bilateral transcranial Doppler sonography and non‐invasive ABP recordings (Finapres, 2300, Ohmeda, Englewood, CO, USA). After an initial biphasic oscillation, cerebral blood flow velocity (CBFV) and ABP decreased to below baseline. CBFV reincreased in controls and on contralateral sides in patients 6·0 s (3·8–9·5 s, median and range) after the onset of the decrease, despite a further fall in ABP. CBFV over the affected side revealed a significantly delayed reincrease (8·0 (5·6–10·3) s; P |
| doi_str_mv | 10.1046/j.1365-2281.2001.00322.x |
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The aim of the present study was to investigate (1) whether these changes could be applied to detect impaired dynamic cerebral autoregulation (dCA) in carotid stenosis and (2) whether the degree of indicated impairment correlates with transfer function phase as another current measure for dCA (deep breathing method) and CO2‐reactivity. We examined 13 patients with severe unilateral carotid artery stenosis and 16 age‐matched controls during 15‐s Mueller manoeuvres (MM) at −30 mmHg using bilateral transcranial Doppler sonography and non‐invasive ABP recordings (Finapres, 2300, Ohmeda, Englewood, CO, USA). After an initial biphasic oscillation, cerebral blood flow velocity (CBFV) and ABP decreased to below baseline. CBFV reincreased in controls and on contralateral sides in patients 6·0 s (3·8–9·5 s, median and range) after the onset of the decrease, despite a further fall in ABP. CBFV over the affected side revealed a significantly delayed reincrease (8·0 (5·6–10·3) s; P<0·01) combined with a relatively flat and inertial amplitude behaviour. An applied autoregulation index derived from the MM (mROR), phase shift and CO2‐reactivity were severely reduced on the affected side in patients (P<0·01). Reduction of the mROR correlated significantly with reduction of phase shift (r=0·69; P=0·002) and CO2‐reactivity (r=0·78; P=0·002). In conclusion, the different cerebral haemodynamic pattern during the MM in patients is likely to reflect impaired dCA. The degree of indicated impairment correlates with that of transfer function phase and CO2‐reactivity. Therefore, the MM represents a convenient method for grading of compromised cerebral haemodynamics in patients with carotid artery stenosis.</description><identifier>ISSN: 0144-5979</identifier><identifier>EISSN: 1365-2281</identifier><identifier>DOI: 10.1046/j.1365-2281.2001.00322.x</identifier><identifier>PMID: 11318831</identifier><identifier>CODEN: CLPHDU</identifier><language>eng</language><publisher>Oxford UK: Blackwell Science Ltd</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Blood Pressure - physiology ; Carbon Dioxide - metabolism ; carotid artery stenosis ; Carotid Stenosis - complications ; Case-Control Studies ; Cerebral Cortex - blood supply ; CO2-reactivity ; Female ; Hemodynamics ; Humans ; Male ; Medical sciences ; Middle Aged ; Neurology ; Pulmonary Ventilation ; Regional Blood Flow ; transcranial Doppler sonography ; transfer function analysis ; Ultrasonography, Doppler, Transcranial ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Clinical physiology (Oxford), 2001-03, Vol.21 (2), p.229-237</ispartof><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4302-d3a4d330562b9274e0570c117390ab5228db160f27ab2f4465af791b08a997a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2281.2001.00322.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2281.2001.00322.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=963274$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11318831$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reinhard, Matthias</creatorcontrib><creatorcontrib>Hetzel, Andreas</creatorcontrib><creatorcontrib>Lauk, Michael</creatorcontrib><creatorcontrib>Lücking, Carl H.</creatorcontrib><title>Evaluation of impaired dynamic cerebral autoregulation by the Mueller manoeuvre</title><title>Clinical physiology (Oxford)</title><addtitle>Clin Physiol</addtitle><description>Arterial blood pressure (ABP) shows polyphasic changes during the Mueller manoeuvre (voluntary negative intrathoracic pressure). The aim of the present study was to investigate (1) whether these changes could be applied to detect impaired dynamic cerebral autoregulation (dCA) in carotid stenosis and (2) whether the degree of indicated impairment correlates with transfer function phase as another current measure for dCA (deep breathing method) and CO2‐reactivity. We examined 13 patients with severe unilateral carotid artery stenosis and 16 age‐matched controls during 15‐s Mueller manoeuvres (MM) at −30 mmHg using bilateral transcranial Doppler sonography and non‐invasive ABP recordings (Finapres, 2300, Ohmeda, Englewood, CO, USA). After an initial biphasic oscillation, cerebral blood flow velocity (CBFV) and ABP decreased to below baseline. CBFV reincreased in controls and on contralateral sides in patients 6·0 s (3·8–9·5 s, median and range) after the onset of the decrease, despite a further fall in ABP. CBFV over the affected side revealed a significantly delayed reincrease (8·0 (5·6–10·3) s; P<0·01) combined with a relatively flat and inertial amplitude behaviour. An applied autoregulation index derived from the MM (mROR), phase shift and CO2‐reactivity were severely reduced on the affected side in patients (P<0·01). Reduction of the mROR correlated significantly with reduction of phase shift (r=0·69; P=0·002) and CO2‐reactivity (r=0·78; P=0·002). In conclusion, the different cerebral haemodynamic pattern during the MM in patients is likely to reflect impaired dCA. The degree of indicated impairment correlates with that of transfer function phase and CO2‐reactivity. Therefore, the MM represents a convenient method for grading of compromised cerebral haemodynamics in patients with carotid artery stenosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure - physiology</subject><subject>Carbon Dioxide - metabolism</subject><subject>carotid artery stenosis</subject><subject>Carotid Stenosis - complications</subject><subject>Case-Control Studies</subject><subject>Cerebral Cortex - blood supply</subject><subject>CO2-reactivity</subject><subject>Female</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Pulmonary Ventilation</subject><subject>Regional Blood Flow</subject><subject>transcranial Doppler sonography</subject><subject>transfer function analysis</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0144-5979</issn><issn>1365-2281</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkEtv1DAURi0EokPhLyBLSOyS-pU4ltjA0Cmt-gBUiaV1k9yAhzymdlJm_j2eZjRsWdmSz-f73UMI5SzlTOVn65TLPEuEKHgqGOMpY1KIdPuMLI4Pz8mCcaWSzGhzQl6FsI6gZJl6SU44l7woJF-Qu_NHaCcY3dDToaGu24DzWNN610PnKlqhx9JDS2EaB48_p3Zmyx0dfyG9mbBt0dMO-gGnR4-vyYsG2oBvDucpuV-d3y-_JNd3F5fLj9dJpSQTSS1B1TK2yUVphFbIMs0qzrU0DMos9q9LnrNGaChFo1SeQaMNL1kBxmiQp-T9_O3GDw8ThtF2LlSxC_Q4TMFqpk10ICNYzGDlhxA8NnbjXQd-Zzmze5d2bffK7F6Z3bu0Ty7tNkbfHmZMZYf1v-BBXgTeHQAIFbSNh75y4ciZXMbNIvVhpv64Fnf_Pd4uv67iJcaTOe7CiNtjHPxvm2upM_vj9sJ-umKr79-ktJ_lXyQWnQQ</recordid><startdate>200103</startdate><enddate>200103</enddate><creator>Reinhard, Matthias</creator><creator>Hetzel, Andreas</creator><creator>Lauk, Michael</creator><creator>Lücking, Carl H.</creator><general>Blackwell Science Ltd</general><general>Blackwell Science</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200103</creationdate><title>Evaluation of impaired dynamic cerebral autoregulation by the Mueller manoeuvre</title><author>Reinhard, Matthias ; Hetzel, Andreas ; Lauk, Michael ; Lücking, Carl H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4302-d3a4d330562b9274e0570c117390ab5228db160f27ab2f4465af791b08a997a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure - physiology</topic><topic>Carbon Dioxide - metabolism</topic><topic>carotid artery stenosis</topic><topic>Carotid Stenosis - complications</topic><topic>Case-Control Studies</topic><topic>Cerebral Cortex - blood supply</topic><topic>CO2-reactivity</topic><topic>Female</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Pulmonary Ventilation</topic><topic>Regional Blood Flow</topic><topic>transcranial Doppler sonography</topic><topic>transfer function analysis</topic><topic>Ultrasonography, Doppler, Transcranial</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reinhard, Matthias</creatorcontrib><creatorcontrib>Hetzel, Andreas</creatorcontrib><creatorcontrib>Lauk, Michael</creatorcontrib><creatorcontrib>Lücking, Carl H.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical physiology (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reinhard, Matthias</au><au>Hetzel, Andreas</au><au>Lauk, Michael</au><au>Lücking, Carl H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of impaired dynamic cerebral autoregulation by the Mueller manoeuvre</atitle><jtitle>Clinical physiology (Oxford)</jtitle><addtitle>Clin Physiol</addtitle><date>2001-03</date><risdate>2001</risdate><volume>21</volume><issue>2</issue><spage>229</spage><epage>237</epage><pages>229-237</pages><issn>0144-5979</issn><eissn>1365-2281</eissn><coden>CLPHDU</coden><abstract>Arterial blood pressure (ABP) shows polyphasic changes during the Mueller manoeuvre (voluntary negative intrathoracic pressure). The aim of the present study was to investigate (1) whether these changes could be applied to detect impaired dynamic cerebral autoregulation (dCA) in carotid stenosis and (2) whether the degree of indicated impairment correlates with transfer function phase as another current measure for dCA (deep breathing method) and CO2‐reactivity. We examined 13 patients with severe unilateral carotid artery stenosis and 16 age‐matched controls during 15‐s Mueller manoeuvres (MM) at −30 mmHg using bilateral transcranial Doppler sonography and non‐invasive ABP recordings (Finapres, 2300, Ohmeda, Englewood, CO, USA). After an initial biphasic oscillation, cerebral blood flow velocity (CBFV) and ABP decreased to below baseline. CBFV reincreased in controls and on contralateral sides in patients 6·0 s (3·8–9·5 s, median and range) after the onset of the decrease, despite a further fall in ABP. CBFV over the affected side revealed a significantly delayed reincrease (8·0 (5·6–10·3) s; P<0·01) combined with a relatively flat and inertial amplitude behaviour. An applied autoregulation index derived from the MM (mROR), phase shift and CO2‐reactivity were severely reduced on the affected side in patients (P<0·01). Reduction of the mROR correlated significantly with reduction of phase shift (r=0·69; P=0·002) and CO2‐reactivity (r=0·78; P=0·002). In conclusion, the different cerebral haemodynamic pattern during the MM in patients is likely to reflect impaired dCA. The degree of indicated impairment correlates with that of transfer function phase and CO2‐reactivity. Therefore, the MM represents a convenient method for grading of compromised cerebral haemodynamics in patients with carotid artery stenosis.</abstract><cop>Oxford UK</cop><pub>Blackwell Science Ltd</pub><pmid>11318831</pmid><doi>10.1046/j.1365-2281.2001.00322.x</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Blood Pressure - physiology Carbon Dioxide - metabolism carotid artery stenosis Carotid Stenosis - complications Case-Control Studies Cerebral Cortex - blood supply CO2-reactivity Female Hemodynamics Humans Male Medical sciences Middle Aged Neurology Pulmonary Ventilation Regional Blood Flow transcranial Doppler sonography transfer function analysis Ultrasonography, Doppler, Transcranial Vascular diseases and vascular malformations of the nervous system |
| title | Evaluation of impaired dynamic cerebral autoregulation by the Mueller manoeuvre |
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