Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease
In patients with sickle cell disease (SCD) the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Meeting demands for oxygen delivery requires compensatory features of brain perfusion. The cerebral vasculature’s regulatory function and...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-03-01
|
| Series: | Frontiers in Physiology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphys.2022.847969/full |
| _version_ | 1819158743146823680 |
|---|---|
| author | Ece Su Sayin Ece Su Sayin Olivia Sobczyk Olivia Sobczyk Julien Poublanc David J. Mikulis David J. Mikulis Joseph A. Fisher Joseph A. Fisher Joseph A. Fisher Kevin H. M. Kuo James Duffin James Duffin |
| author_facet | Ece Su Sayin Ece Su Sayin Olivia Sobczyk Olivia Sobczyk Julien Poublanc David J. Mikulis David J. Mikulis Joseph A. Fisher Joseph A. Fisher Joseph A. Fisher Kevin H. M. Kuo James Duffin James Duffin |
| author_sort | Ece Su Sayin |
| collection | DOAJ |
| description | In patients with sickle cell disease (SCD) the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Meeting demands for oxygen delivery requires compensatory features of brain perfusion. The cerebral vasculature’s regulatory function and reserves can be assessed by observing the flow response to a vasoactive stimulus. In a traditional approach we measured voxel-wise change in Blood Oxygen-Level Dependent (BOLD) MRI signal as a surrogate of cerebral blood flow (CBF) in response to a linear progressive ramping of end-tidal partial pressure of carbon dioxide (PETCO2). Cerebrovascular reactivity (CVR) was defined as ΔBOLD/ΔPETCO2. We used a computer model to fit a virtual sigmoid resistance curve to the progressive CBF response to the stimulus, enabling the calculation of resistance parameters: amplitude, midpoint, range response, resistance sensitivity and vasodilatory reserve. The quality of the resistance sigmoid fit was expressed as the r2 of the fit. We tested 35 patients with SCD, as well as 24 healthy subjects to provide an indication of the normal ranges of the resistance parameters. We found that gray matter CVR and resistance amplitude, range, reserve, and sensitivity are reduced in patients with SCD compared to healthy controls, while resistance midpoint was increased. This study is the first to document resistance measures in adult patients with SCD. It is also the first to score these vascular resistance measures in comparison to the normal range. We anticipate these data will complement the current understanding of the cerebral vascular pathophysiology of SCD, identify paths for therapeutic interventions, and provide biomarkers for monitoring the progress of the disease. |
| first_indexed | 2024-12-22T16:29:30Z |
| format | Article |
| id | doaj.art-461cb4c9f69f425dacff27abf7daba42 |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-22T16:29:30Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-461cb4c9f69f425dacff27abf7daba422022-12-21T18:20:05ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2022-03-011310.3389/fphys.2022.847969847969Assessing Cerebrovascular Resistance in Patients With Sickle Cell DiseaseEce Su Sayin0Ece Su Sayin1Olivia Sobczyk2Olivia Sobczyk3Julien Poublanc4David J. Mikulis5David J. Mikulis6Joseph A. Fisher7Joseph A. Fisher8Joseph A. Fisher9Kevin H. M. Kuo10James Duffin11James Duffin12Department of Physiology, University of Toronto, Toronto, ON, CanadaDepartment of Anaesthesia and Pain Management, University Health Network, Toronto, ON, CanadaDepartment of Anaesthesia and Pain Management, University Health Network, Toronto, ON, CanadaJoint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, CanadaJoint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, CanadaJoint Department of Medical Imaging and the Functional Neuroimaging Laboratory, University Health Network, Toronto, ON, CanadaInstitute of Medical Sciences, University of Toronto, Toronto, ON, CanadaDepartment of Physiology, University of Toronto, Toronto, ON, CanadaDepartment of Anaesthesia and Pain Management, University Health Network, Toronto, ON, CanadaInstitute of Medical Sciences, University of Toronto, Toronto, ON, CanadaDivision of Hematology, Department of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Physiology, University of Toronto, Toronto, ON, CanadaDepartment of Anaesthesia and Pain Management, University Health Network, Toronto, ON, CanadaIn patients with sickle cell disease (SCD) the delivery of oxygen to the brain is compromised by anemia, abnormal rheology, and steno-occlusive vascular disease. Meeting demands for oxygen delivery requires compensatory features of brain perfusion. The cerebral vasculature’s regulatory function and reserves can be assessed by observing the flow response to a vasoactive stimulus. In a traditional approach we measured voxel-wise change in Blood Oxygen-Level Dependent (BOLD) MRI signal as a surrogate of cerebral blood flow (CBF) in response to a linear progressive ramping of end-tidal partial pressure of carbon dioxide (PETCO2). Cerebrovascular reactivity (CVR) was defined as ΔBOLD/ΔPETCO2. We used a computer model to fit a virtual sigmoid resistance curve to the progressive CBF response to the stimulus, enabling the calculation of resistance parameters: amplitude, midpoint, range response, resistance sensitivity and vasodilatory reserve. The quality of the resistance sigmoid fit was expressed as the r2 of the fit. We tested 35 patients with SCD, as well as 24 healthy subjects to provide an indication of the normal ranges of the resistance parameters. We found that gray matter CVR and resistance amplitude, range, reserve, and sensitivity are reduced in patients with SCD compared to healthy controls, while resistance midpoint was increased. This study is the first to document resistance measures in adult patients with SCD. It is also the first to score these vascular resistance measures in comparison to the normal range. We anticipate these data will complement the current understanding of the cerebral vascular pathophysiology of SCD, identify paths for therapeutic interventions, and provide biomarkers for monitoring the progress of the disease.https://www.frontiersin.org/articles/10.3389/fphys.2022.847969/fullsickle cell diseasecerebrovascular reactivity (CVR)hypercapnic stimulusmagnetic resonance imagingcerebrovascular resistance |
| spellingShingle | Ece Su Sayin Ece Su Sayin Olivia Sobczyk Olivia Sobczyk Julien Poublanc David J. Mikulis David J. Mikulis Joseph A. Fisher Joseph A. Fisher Joseph A. Fisher Kevin H. M. Kuo James Duffin James Duffin Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease Frontiers in Physiology sickle cell disease cerebrovascular reactivity (CVR) hypercapnic stimulus magnetic resonance imaging cerebrovascular resistance |
| title | Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease |
| title_full | Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease |
| title_fullStr | Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease |
| title_full_unstemmed | Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease |
| title_short | Assessing Cerebrovascular Resistance in Patients With Sickle Cell Disease |
| title_sort | assessing cerebrovascular resistance in patients with sickle cell disease |
| topic | sickle cell disease cerebrovascular reactivity (CVR) hypercapnic stimulus magnetic resonance imaging cerebrovascular resistance |
| url | https://www.frontiersin.org/articles/10.3389/fphys.2022.847969/full |
| work_keys_str_mv | AT ecesusayin assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT ecesusayin assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT oliviasobczyk assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT oliviasobczyk assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT julienpoublanc assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT davidjmikulis assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT davidjmikulis assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT josephafisher assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT josephafisher assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT josephafisher assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT kevinhmkuo assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT jamesduffin assessingcerebrovascularresistanceinpatientswithsicklecelldisease AT jamesduffin assessingcerebrovascularresistanceinpatientswithsicklecelldisease |