Kiran Prakash1, Dinu S Chandran1, Rajesh Khadgawat2, Ashok Kumar Jaryal3, Kishore Kumar Deepak1. 1. Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. 2. Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: ashok.jaryal@gmail.com.
Abstract
BACKGROUND: Changes in cerebral blood flow velocity to hypercapnia are associated with changes in systemic blood pressure (BP). These confounding BP-dependent changes in cerebral blood flow velocity cause misinterpretation of cerebrovascular reactivity (CVR) results. The objective of the study was to determine the relationship between CVR assessed by breath holding and 6% CO2 breathing after correcting for BP-dependent changes in cerebral blood flow velocity. METHODS: In 33 patients of uncomplicated type 2 diabetes mellitus, CVR was assessed as percentage changes in cerebral blood flow velocity and cerebrovascular conductance index. RESULTS: Percentage change in cerebral blood flow velocity during breath holding was positively correlated with that of during 6% CO2 breathing (r = .35; P = .0448). CVR during breath holding and 6% CO2 breathing were better correlated when expressed as percentage changes in cerebrovascular conductance index (r = .49; P = .0040). Similarly, breath-holding test results expressed as percentage changes in cerebral blood flow velocity correctly identified only 37.5% of the poor reactors to 6% CO2 breathing. However, when the breath-holding test results were expressed as percentage changes in cerebrovascular conductance index, 62.5% of the poor reactors to 6% CO2 breathing were correctly identified indicating a better agreement between the test results obtained by the 2 methods. CONCLUSION: Cerebrovascular response to breath holding is better correlated with that of 6% CO2 breathing when changes in cerebral blood flow velocity were corrected for associated changes in BP.
BACKGROUND: Changes in cerebral blood flow velocity to hypercapnia are associated with changes in systemic blood pressure (BP). These confounding BP-dependent changes in cerebral blood flow velocity cause misinterpretation of cerebrovascular reactivity (CVR) results. The objective of the study was to determine the relationship between CVR assessed by breath holding and 6% CO2 breathing after correcting for BP-dependent changes in cerebral blood flow velocity. METHODS: In 33 patients of uncomplicated type 2 diabetes mellitus, CVR was assessed as percentage changes in cerebral blood flow velocity and cerebrovascular conductance index. RESULTS: Percentage change in cerebral blood flow velocity during breath holding was positively correlated with that of during 6% CO2 breathing (r = .35; P = .0448). CVR during breath holding and 6% CO2 breathing were better correlated when expressed as percentage changes in cerebrovascular conductance index (r = .49; P = .0040). Similarly, breath-holding test results expressed as percentage changes in cerebral blood flow velocity correctly identified only 37.5% of the poor reactors to 6% CO2 breathing. However, when the breath-holding test results were expressed as percentage changes in cerebrovascular conductance index, 62.5% of the poor reactors to 6% CO2 breathing were correctly identified indicating a better agreement between the test results obtained by the 2 methods. CONCLUSION: Cerebrovascular response to breath holding is better correlated with that of 6% CO2 breathing when changes in cerebral blood flow velocity were corrected for associated changes in BP.