4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES
Background: High pulsatility index (PI) in the cerebral circulation has been associated with increased prevalence of stroke (1). Interestingly, heart failure (HF) patients implanted with continuous-flow left ventricular assist devices (CF-LVADs) have increased rates of stroke despite presenting with...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | Artery Research |
| Online Access: | https://www.atlantis-press.com/article/125930200/view |
| _version_ | 1828499147331731456 |
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| author | Eric Stöhr Francesco Castagna James Pearson Laura Watkeys Samuel Trocio Oksana Zatvarska Timothy Crimmins Alberto Pinsino Paolo Colombo Melana Yuzefpolskaya Reshad Garan Veli Topkara Hiroo Takayama Koji Takeda Yoshifumi Naka John Cockcroft Joshua Willey Barry McDonnell |
| author_facet | Eric Stöhr Francesco Castagna James Pearson Laura Watkeys Samuel Trocio Oksana Zatvarska Timothy Crimmins Alberto Pinsino Paolo Colombo Melana Yuzefpolskaya Reshad Garan Veli Topkara Hiroo Takayama Koji Takeda Yoshifumi Naka John Cockcroft Joshua Willey Barry McDonnell |
| author_sort | Eric Stöhr |
| collection | DOAJ |
| description | Background: High pulsatility index (PI) in the cerebral circulation has been associated with increased prevalence of stroke (1). Interestingly, heart failure (HF) patients implanted with continuous-flow left ventricular assist devices (CF-LVADs) have increased rates of stroke despite presenting with dramatically lower pulse pressures compared with healthy individuals (20 mmHg vs. 30–40 mmHg). Characterising and understanding flow velocity profiles of the middle cerebral artery (MCA) may provide a useful and local marker of pulsatile energy transmitted into the brain of HF and CF-LVAD patients.
Methods: PI and resistance index (RI) were quantified from Duplex ultrasound images (2D and pulsed-wave Doppler) of the MCA obtained in four heart failure patients (HF; 68 ± 7 yrs), eight CF-LVAD patients (59 ± 4 yrs) and 20 healthy controls (51 ± 7 yrs).
Results: Compared with healthy controls, PI of the MCA was actually higher in the HF group (0.72 ± 0.16 vs. 1.32 ± 0.17, P < 0.0001), but markedly lower in patients on CF-LVAD (0.36 ± 0.21, P < 0.0001). However, RI was similar between healthy controls and HF patients (P > 0.05), and only lower in CF-LVAD patients (P < 0.0001).
Conclusions: PI in the MCA is significantly higher in HF but markedly lower in CF-LVAD patients, relative to healthy controls. The higher PI in HF does not appear to be associated with an altered RI. Future work should examine the cerebrovascular outcomes associated with varying levels of pulsatility and resistance in both HF and CF-LVAD patients. |
| first_indexed | 2024-12-11T13:19:37Z |
| format | Article |
| id | doaj.art-f7cb38492a104d18aeebd26ca25e98cf |
| institution | Directory Open Access Journal |
| issn | 1876-4401 |
| language | English |
| last_indexed | 2024-12-11T13:19:37Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Artery Research |
| spelling | doaj.art-f7cb38492a104d18aeebd26ca25e98cf2022-12-22T01:05:55ZengBMCArtery Research1876-44012017-12-012010.1016/j.artres.2017.10.0424.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICESEric StöhrFrancesco CastagnaJames PearsonLaura WatkeysSamuel TrocioOksana ZatvarskaTimothy CrimminsAlberto PinsinoPaolo ColomboMelana YuzefpolskayaReshad GaranVeli TopkaraHiroo TakayamaKoji TakedaYoshifumi NakaJohn CockcroftJoshua WilleyBarry McDonnellBackground: High pulsatility index (PI) in the cerebral circulation has been associated with increased prevalence of stroke (1). Interestingly, heart failure (HF) patients implanted with continuous-flow left ventricular assist devices (CF-LVADs) have increased rates of stroke despite presenting with dramatically lower pulse pressures compared with healthy individuals (20 mmHg vs. 30–40 mmHg). Characterising and understanding flow velocity profiles of the middle cerebral artery (MCA) may provide a useful and local marker of pulsatile energy transmitted into the brain of HF and CF-LVAD patients. Methods: PI and resistance index (RI) were quantified from Duplex ultrasound images (2D and pulsed-wave Doppler) of the MCA obtained in four heart failure patients (HF; 68 ± 7 yrs), eight CF-LVAD patients (59 ± 4 yrs) and 20 healthy controls (51 ± 7 yrs). Results: Compared with healthy controls, PI of the MCA was actually higher in the HF group (0.72 ± 0.16 vs. 1.32 ± 0.17, P < 0.0001), but markedly lower in patients on CF-LVAD (0.36 ± 0.21, P < 0.0001). However, RI was similar between healthy controls and HF patients (P > 0.05), and only lower in CF-LVAD patients (P < 0.0001). Conclusions: PI in the MCA is significantly higher in HF but markedly lower in CF-LVAD patients, relative to healthy controls. The higher PI in HF does not appear to be associated with an altered RI. Future work should examine the cerebrovascular outcomes associated with varying levels of pulsatility and resistance in both HF and CF-LVAD patients.https://www.atlantis-press.com/article/125930200/view |
| spellingShingle | Eric Stöhr Francesco Castagna James Pearson Laura Watkeys Samuel Trocio Oksana Zatvarska Timothy Crimmins Alberto Pinsino Paolo Colombo Melana Yuzefpolskaya Reshad Garan Veli Topkara Hiroo Takayama Koji Takeda Yoshifumi Naka John Cockcroft Joshua Willey Barry McDonnell 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES Artery Research |
| title | 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES |
| title_full | 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES |
| title_fullStr | 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES |
| title_full_unstemmed | 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES |
| title_short | 4.4 MIDDLE CEREBRAL ARTERY PULSATILITY IN HEART FAILURE AND PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES |
| title_sort | 4 4 middle cerebral artery pulsatility in heart failure and patients with continuous flow left ventricular assist devices |
| url | https://www.atlantis-press.com/article/125930200/view |
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