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Can we assess dynamic cerebral autoregulation in stroke patients with high rates of cardiac ectopicity?

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Abstract

It is unclear whether physiological recordings containing high numbers of ectopic heartbeats can be used to measure the cerebral autoregulation (CA) of blood flow. This study evaluated the utility of such data for assessing dynamic CA capacity. Physiological recordings of cerebral blood flow velocity, heart rate, end-tidal CO2 and beat-to-beat blood pressure from acute ischaemic stroke (AIS) patients (n = 46) containing ectopic heartbeats of varying number (0.2 to 25 occurrences per minute) were analysed. Dynamic CA was determined using the autoregulation index (ARI) and the normalised mean square error (NMSE) was used to evaluate the fitting of the step response between BP and CBFV to Tiecks’ model. We fitted linear mixed models on the CA variables incorporating ectopic burden, age, sex and hemisphere as predictor variables. Ectopic activity demonstrated an association with mean coherence (p = 0.006) but not with ARI (p = 0.162), impaired CA based on dichotomised ARI (p = 0.859) or NMSE (p = 0.671). Dynamic CA could be reliably assessed in AIS patients using physiological recordings with high rates of cardiac ectopic activity. This provides supportive data for future studies evaluating CA capability in AIS patients, with the potential to develop more individualised treatment strategies.

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Acknowledgements

TGR is a National Institute for Health Research Senior Investigator.

Funding

This study was supported by UK Engineering and Physical Sciences Research Council (grant No. EP/K041207/1).

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, University of Leicester, Room 225, Level 2, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK

    Osian Llwyd, Victoria Haunton, Angela S.M. Salinet, Mintu Nath, Man Y. Lam, Nazia P. Saeed, Fiona Brodie, Thompson G. Robinson & Ronney B. Panerai

  2. NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK

    Victoria Haunton, Mintu Nath, Thompson G. Robinson & Ronney B. Panerai

Authors
  1. Osian Llwyd
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  2. Victoria Haunton
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  5. Man Y. Lam
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  9. Ronney B. Panerai
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Contributions

Study design: O.LL, V.H., T.G.R., R.B.P. Patient recruitment, data collection and data preparation: O.LL, A.S.M.S., M.Y.L, N.P.S., F.B. Data analysis: OLL, M.N. Interpretation of data: O.LL, V.H., M.N., T.G.R., R.B.P. Drafted manuscript: O.LL, V.H., M.N., T.G.R., R.B.P. Edited and revised manuscript: O.LL, V.H., M.N., T.G.R., R.B.P. Approved final version of manuscript: O.LL, V.H., M.N., T.G.R., R.B.P.

Corresponding author

Correspondence to Ronney B. Panerai.

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Llwyd, O., Haunton, V., Salinet, A.S. et al. Can we assess dynamic cerebral autoregulation in stroke patients with high rates of cardiac ectopicity?. Med Biol Eng Comput 57, 2731–2739 (2019). https://doi.org/10.1007/s11517-019-02064-0

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  • DOI: https://doi.org/10.1007/s11517-019-02064-0

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