Assessment of cerebral hemodynamic parameters using pulsatile versus non-pulsatile cerebral blood outflow models
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Prior methods evaluating the changes in cerebral arterial blood volume (∆CaBV) assumed that brain blood transport distal to big cerebral arteries can be approximated with a non-pulsatile flow (CFF) model. In this study, a modified ∆CaBV calculation that accounts for pulsatile blood flow forward (PFF) from large cerebral arteries to resistive arterioles was investigated. The aim was to assess cerebral hemodynamic indices estimated by both CFF and PFF models while changing arterial blood carbon dioxide concentration (EtCO2) in healthy volunteers.
Materials and methods
Continuous recordings of non-invasive arterial blood pressure (ABP), transcranial Doppler blood flow velocity (CBFVa), and EtCO2 were performed in 53 young volunteers at baseline and during both hypo- and hypercapnia. The time constant of the cerebral arterial bed (τ) and critical closing pressure (CrCP) were estimated using mathematical transformations of the pulse waveforms of ABP and CBFVa, and with both pulsatile and non-pulsatile models of ∆CaBV estimation. Results are presented as median values ± interquartile range.
Both CrCP and τ gave significantly lower values with the PFF model when compared with the CFF model (p ≪ 0.001 for both). In comparison to normocapnia, both CrCP and τ determined with the PFF model increased during hypocapnia [CrCPPFF (mm Hg): 5.52 ± 8.78 vs. 14.36 ± 14.47, p = 0.00006; τPFF (ms): 47.4 ± 53.9 vs. 72.8 ± 45.7, p = 0.002] and decreased during hypercapnia [CrCPPFF (mm Hg): 5.52 ± 8.78 vs. 2.36 ± 7.05, p = 0.0001; τPFF (ms): 47.4 ± 53.9 vs. 29.0 ± 31.3, p = 0.0003]. When the CFF model was applied, no changes were found for CrCP during hypercapnia or in τ during hypocapnia.
Our results suggest that the pulsatile flow forward model better reflects changes in CrCP and in τ induced by controlled alterations in EtCO2.
KeywordsTranscranial Doppler ultrasound Cerebral arterial blood volume Cerebral arterial compliance Time constant of cerebral arterial bed Critical closing pressure Hypercapnia Hypocapnia
We thank Krystian Gruszczyński, Msc. Eng. for assistance with data collection and Tomasz Szczepański, PhD for reviewing medical history and physical examination.
This research was supported by the National Science Center (Poland) under Grant No. UMO-2013/10/E/ST7/00117.
Compliance with ethical standards
Conflict of interest
ICM + Software is licensed by Cambridge Enterprise, Cambridge, UK, http://www.neurosurg.cam.ac.uk/icmplus/. Prof. Czosnyka has a financial interest in a fraction of the licensing fee for ICM + software. The other authors declare that they have no conflicts of interest.
The protocol complied with the Declaration of Helsinki of the World Medical Association, and all participants gave written informed consent before participating in the study.
Research involving human and animal rights
The study was approved by the bioethical committee of the Wroclaw Medical University (Permission No. KB-170/2014).
- 17.Czosnyka M, Smielewski P, Kirkpatrick P, Piechnik S, Laing R, Pickard JD. Continuous monitoring of cerebrovascular pressure-reactivity in head injury. Acta Neurochir Suppl. 1998;71:74–7.Google Scholar
- 20.Valdueza JM, Balzer JO, Villringer A, Vogl TJ, Kutter R, Einhäupl KM. Changes in blood flow velocity and diameter of the middle cerebral artery during hyperventilation: assessment with MR and transcranial Doppler sonography. Am J Neuroradiol. 1997;18:1929–34.Google Scholar
- 30.Schreiber SJ, Gottschalk S, Weih M, Villringer A, Valdueza JM. Assessment of blood flow velocity and diameter of the middle cerebral artery during the acetazolamide provocation test by use of transcranial Doppler sonography and MR imaging. AJNR Am J Neuroradiol. 2000;21:1207–11.Google Scholar