Can cerebrovascular reactivity be assessed without measuring blood pressure in patients with carotid artery disease?
Conventional methods of assessing cerebrovascular reactivity (CVR) omit the influence of blood pressure (BP). This study demonstrates the significant influence of BP during the assessment of CVR in patients with carotid artery disease. In 56 subjects the CVR was bilaterally assessed by measurement o...
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| Veröffentlicht in: | Stroke (1970) 1998-05, Vol.29 (5), p.968-974 |
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| creator | DUMVILLE, J PANERAI, R. B LENNARD, N. S NAYLOR, A. R EVANS, D. H |
| description | Conventional methods of assessing cerebrovascular reactivity (CVR) omit the influence of blood pressure (BP). This study demonstrates the significant influence of BP during the assessment of CVR in patients with carotid artery disease.
In 56 subjects the CVR was bilaterally assessed by measurement of cerebral blood flow velocity change in response to inhalation of 5% CO2 in air while BP was continuously monitored. Three methods of calculating the CVR were used: the conventional ratio between relative cerebral blood flow velocity and end-tidal CO2, simple linear regression, and multiple linear regression analysis (MLRA). The clinical significance of the difference in CVR indices was evaluated. The Bland-Altman test was applied to quantify the comparability and bias between measurements. The magnitude and significance of a change in BP during the CVR assessment were calculated in conjunction with an estimate of the velocity change attributed to the BP. The statistical significance of the data segment length on the variability and magnitude of the CVR index was computed.
The value of the CVR index was reduced by 20% and 6% in comparison to the conventional ratio approach when MLRA and linear regression were applied, respectively. With the use of MLRA, in 96% of cases the value of the BP coefficient was statistically significant, and in four patients the increase in velocity was primarily attributed to the increase in BP.
The influence of BP is significant and requires consideration when the CVR index is calculated in patients with carotid artery disease. |
| doi_str_mv | 10.1161/01.STR.29.5.968 |
| format | Article |
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In 56 subjects the CVR was bilaterally assessed by measurement of cerebral blood flow velocity change in response to inhalation of 5% CO2 in air while BP was continuously monitored. Three methods of calculating the CVR were used: the conventional ratio between relative cerebral blood flow velocity and end-tidal CO2, simple linear regression, and multiple linear regression analysis (MLRA). The clinical significance of the difference in CVR indices was evaluated. The Bland-Altman test was applied to quantify the comparability and bias between measurements. The magnitude and significance of a change in BP during the CVR assessment were calculated in conjunction with an estimate of the velocity change attributed to the BP. The statistical significance of the data segment length on the variability and magnitude of the CVR index was computed.
The value of the CVR index was reduced by 20% and 6% in comparison to the conventional ratio approach when MLRA and linear regression were applied, respectively. With the use of MLRA, in 96% of cases the value of the BP coefficient was statistically significant, and in four patients the increase in velocity was primarily attributed to the increase in BP.
The influence of BP is significant and requires consideration when the CVR index is calculated in patients with carotid artery disease.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.29.5.968</identifier><identifier>PMID: 9596244</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Biological and medical sciences ; Blood Flow Velocity - drug effects ; Blood Flow Velocity - physiology ; Blood Pressure - drug effects ; Blood Pressure - physiology ; Carbon Dioxide - administration & dosage ; Carbon Dioxide - pharmacology ; Cardiovascular system ; Cardiovascular System - physiopathology ; Carotid Artery Diseases - physiopathology ; Cerebral Arteries - drug effects ; Cerebral Arteries - physiopathology ; Cerebrovascular Circulation - drug effects ; Cerebrovascular Circulation - physiology ; Heart Rate - drug effects ; Heart Rate - physiology ; Humans ; Hypercapnia - physiopathology ; Investigative techniques, diagnostic techniques (general aspects) ; Linear Models ; Medical sciences ; Middle Aged ; Partial Pressure ; Tidal Volume ; Time Factors ; Ultrasonic investigative techniques</subject><ispartof>Stroke (1970), 1998-05, Vol.29 (5), p.968-974</ispartof><rights>1998 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. May 1998</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-7e612b1182a602cdd5bb3506c005cd3e44530aaa07b487c2c98abe4c39981f323</citedby><cites>FETCH-LOGICAL-c424t-7e612b1182a602cdd5bb3506c005cd3e44530aaa07b487c2c98abe4c39981f323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3673,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2234948$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9596244$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DUMVILLE, J</creatorcontrib><creatorcontrib>PANERAI, R. B</creatorcontrib><creatorcontrib>LENNARD, N. S</creatorcontrib><creatorcontrib>NAYLOR, A. R</creatorcontrib><creatorcontrib>EVANS, D. H</creatorcontrib><title>Can cerebrovascular reactivity be assessed without measuring blood pressure in patients with carotid artery disease?</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Conventional methods of assessing cerebrovascular reactivity (CVR) omit the influence of blood pressure (BP). This study demonstrates the significant influence of BP during the assessment of CVR in patients with carotid artery disease.
In 56 subjects the CVR was bilaterally assessed by measurement of cerebral blood flow velocity change in response to inhalation of 5% CO2 in air while BP was continuously monitored. Three methods of calculating the CVR were used: the conventional ratio between relative cerebral blood flow velocity and end-tidal CO2, simple linear regression, and multiple linear regression analysis (MLRA). The clinical significance of the difference in CVR indices was evaluated. The Bland-Altman test was applied to quantify the comparability and bias between measurements. The magnitude and significance of a change in BP during the CVR assessment were calculated in conjunction with an estimate of the velocity change attributed to the BP. The statistical significance of the data segment length on the variability and magnitude of the CVR index was computed.
The value of the CVR index was reduced by 20% and 6% in comparison to the conventional ratio approach when MLRA and linear regression were applied, respectively. With the use of MLRA, in 96% of cases the value of the BP coefficient was statistically significant, and in four patients the increase in velocity was primarily attributed to the increase in BP.
The influence of BP is significant and requires consideration when the CVR index is calculated in patients with carotid artery disease.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood Flow Velocity - drug effects</subject><subject>Blood Flow Velocity - physiology</subject><subject>Blood Pressure - drug effects</subject><subject>Blood Pressure - physiology</subject><subject>Carbon Dioxide - administration & dosage</subject><subject>Carbon Dioxide - pharmacology</subject><subject>Cardiovascular system</subject><subject>Cardiovascular System - physiopathology</subject><subject>Carotid Artery Diseases - physiopathology</subject><subject>Cerebral Arteries - drug effects</subject><subject>Cerebral Arteries - physiopathology</subject><subject>Cerebrovascular Circulation - drug effects</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Heart Rate - drug effects</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Hypercapnia - physiopathology</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Linear Models</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Partial Pressure</subject><subject>Tidal Volume</subject><subject>Time Factors</subject><subject>Ultrasonic investigative techniques</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc2LFDEQxYMo6-zq2ZMQRPbWvfnsTk6yDH7BgqDrOVTSNZqlpzMm6ZX5743usAehoA7v94riPUJecdZzPvArxvtvt197YXvd28E8IRuuherUIMxTsmFM2k4oa5-T81LuGGNCGn1Gzqy2g1BqQ-oWFhowo8_pHkpYZ8g0I4Qa72M9Uo8USsE2E_0d68-0VrpHKGuOyw_q55QmeshNXzPSuNAD1IhLLf9gGiCnGicKuWI-0imWZsV3L8izHcwFX572Bfn-4f3t9lN38-Xj5-31TReUULUbceDCc24EDEyEadLeS82GwJgOk0SltGQAwEavzBhEsAY8qiCtNXwnhbwglw93Dzn9WrFUt48l4DzDgmktbrRmFJLbBr75D7xLa17ab47bcRyYHHiDrh6gkFMpGXfukOMe8tFx5v6W4Rh3rQwnrNOuldEcr09nV7_H6ZE_pd_0tye9JQ_zLsMSYnnEhJDKKiP_ABLwk4U</recordid><startdate>19980501</startdate><enddate>19980501</enddate><creator>DUMVILLE, J</creator><creator>PANERAI, R. B</creator><creator>LENNARD, N. S</creator><creator>NAYLOR, A. R</creator><creator>EVANS, D. H</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><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>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>19980501</creationdate><title>Can cerebrovascular reactivity be assessed without measuring blood pressure in patients with carotid artery disease?</title><author>DUMVILLE, J ; PANERAI, R. B ; LENNARD, N. S ; NAYLOR, A. R ; EVANS, D. H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-7e612b1182a602cdd5bb3506c005cd3e44530aaa07b487c2c98abe4c39981f323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood Flow Velocity - drug effects</topic><topic>Blood Flow Velocity - physiology</topic><topic>Blood Pressure - drug effects</topic><topic>Blood Pressure - physiology</topic><topic>Carbon Dioxide - administration & dosage</topic><topic>Carbon Dioxide - pharmacology</topic><topic>Cardiovascular system</topic><topic>Cardiovascular System - physiopathology</topic><topic>Carotid Artery Diseases - physiopathology</topic><topic>Cerebral Arteries - drug effects</topic><topic>Cerebral Arteries - physiopathology</topic><topic>Cerebrovascular Circulation - drug effects</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Heart Rate - drug effects</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Hypercapnia - physiopathology</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Linear Models</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Partial Pressure</topic><topic>Tidal Volume</topic><topic>Time Factors</topic><topic>Ultrasonic investigative techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DUMVILLE, J</creatorcontrib><creatorcontrib>PANERAI, R. B</creatorcontrib><creatorcontrib>LENNARD, N. S</creatorcontrib><creatorcontrib>NAYLOR, A. R</creatorcontrib><creatorcontrib>EVANS, D. H</creatorcontrib><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>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DUMVILLE, J</au><au>PANERAI, R. B</au><au>LENNARD, N. S</au><au>NAYLOR, A. R</au><au>EVANS, D. H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can cerebrovascular reactivity be assessed without measuring blood pressure in patients with carotid artery disease?</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>1998-05-01</date><risdate>1998</risdate><volume>29</volume><issue>5</issue><spage>968</spage><epage>974</epage><pages>968-974</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Conventional methods of assessing cerebrovascular reactivity (CVR) omit the influence of blood pressure (BP). This study demonstrates the significant influence of BP during the assessment of CVR in patients with carotid artery disease.
In 56 subjects the CVR was bilaterally assessed by measurement of cerebral blood flow velocity change in response to inhalation of 5% CO2 in air while BP was continuously monitored. Three methods of calculating the CVR were used: the conventional ratio between relative cerebral blood flow velocity and end-tidal CO2, simple linear regression, and multiple linear regression analysis (MLRA). The clinical significance of the difference in CVR indices was evaluated. The Bland-Altman test was applied to quantify the comparability and bias between measurements. The magnitude and significance of a change in BP during the CVR assessment were calculated in conjunction with an estimate of the velocity change attributed to the BP. The statistical significance of the data segment length on the variability and magnitude of the CVR index was computed.
The value of the CVR index was reduced by 20% and 6% in comparison to the conventional ratio approach when MLRA and linear regression were applied, respectively. With the use of MLRA, in 96% of cases the value of the BP coefficient was statistically significant, and in four patients the increase in velocity was primarily attributed to the increase in BP.
The influence of BP is significant and requires consideration when the CVR index is calculated in patients with carotid artery disease.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>9596244</pmid><doi>10.1161/01.STR.29.5.968</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Biological and medical sciences Blood Flow Velocity - drug effects Blood Flow Velocity - physiology Blood Pressure - drug effects Blood Pressure - physiology Carbon Dioxide - administration & dosage Carbon Dioxide - pharmacology Cardiovascular system Cardiovascular System - physiopathology Carotid Artery Diseases - physiopathology Cerebral Arteries - drug effects Cerebral Arteries - physiopathology Cerebrovascular Circulation - drug effects Cerebrovascular Circulation - physiology Heart Rate - drug effects Heart Rate - physiology Humans Hypercapnia - physiopathology Investigative techniques, diagnostic techniques (general aspects) Linear Models Medical sciences Middle Aged Partial Pressure Tidal Volume Time Factors Ultrasonic investigative techniques |
| title | Can cerebrovascular reactivity be assessed without measuring blood pressure in patients with carotid artery disease? |
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