Abstract
Impaired cerebrovascular reactivity (CVR) is associated with stroke. Cerebrovascular diseases are common comorbidity in chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to quantify CVR in the anterior and posterior cerebral circulation during voluntary breath-holding in COPD patients according to airflow limitation severity. In this cross-sectional study, we compared 90 COPD patients without previous cerebrovascular disease and 30 age- and sex-matched healthy volunteers (mean age 67 ± 7.9, 87 males). Using transcranial Doppler ultrasound and breath-holding index (BHI), we analysed baseline mean flow velocities (MFV) and CVR of middle cerebral artery (MCA) and basilar artery (BA). Our results demonstrated that COPD patients had lower baseline MFV of both MCA and BA than controls. COPD patients had significantly lower BHImMCA and BHImBA than controls (0.8 and 0.7 versus 1.24 and 1.07, respectively; p < 0.001). With the severity of airflow obstruction, there were significant declines of BHImMCA and BHImBA in mild (0.94 and 0.83), moderate (0.8 and 0.7) and severe to very severe COPD (0.7 and 0.6), respectively (p < 0.001). For all participants, we found a significant and positive correlation between forced expiratory volume in one second (FEV1) and BHImMCA (Rho = 0.761, p < 0.001) and between FEV1 and BHImBA (Rho = 0.409, p < 0.001). COPD patients have impaired CVR in anterior and posterior cerebral circulation. Impairment of CVR increase with the airflow limitation severity. CVR is an appropriate marker to identify vulnerable COPD subjects at high risk to develop cerebrovascular disease. Prospective studies are needed for further evaluation.
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M. Hlavati designed the study, performed the assessments and participant examinations. KB and ST performed the data collection. M. Hlavati, KB, ST and M. Horvat performed the data analysis and interpretation. SBS supervised the measurements. All authors contributed to data interpretation and to the writing of the manuscript. All authors have read and approved the final version of the manuscript.
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The study was approved by the ethics committee of General Hospital Našice (No. 01-497/3-2017) and by ethics committee Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Croatia (No. 2158-61-07-17-209). All data were anonymized and the study was conducted in accordance with the amended Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. All participants signed an informed consent form before entering the study.
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Hlavati, M., Buljan, K., Tomić, S. et al. Impaired cerebrovascular reactivity in chronic obstructive pulmonary disease. Acta Neurol Belg 119, 567–575 (2019). https://doi.org/10.1007/s13760-019-01170-y
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DOI: https://doi.org/10.1007/s13760-019-01170-y