Comparison of visually evoked peak systolic and end diastolic blood flow velocity using a control system approach

Transcranial Doppler sonography measures blood flow velocity in basal cerebral vessels with high accuracy. For quantification, time averaged mean blood flow velocities are used most because the peak systolic and end diastolic blood flow velocities mark the velocity extremes of one heart cycle. It is known, from hemodynamic measurements of the neurovascular coupling mechanism, that the end diastolic velocity is more sensitive for change in hemodynamics than the peak systolic velocity. Thus, we used a recently introduced control system approach to compare both indices for their use in functional transcranial Doppler tests focusing on hemodynamics of blood flow velocity change. We enrolled 65 healthy young volunteers without a medical history of cardiovascular risk factors, and performed a visual stimulation test. Peak systolic and end diastolic maximal blood flow velocities were used after transformation to relative data for control-system analysis. Due to Doppler artefacts, 95% of peak systolic and 86% of end diastolic data sets were analyzed. Results showed statistically significant differences for resting blood flow velocity and the control system parameter gain, attenuation and rate time, whereas the parameters' natural frequency and time delay were equal. Increase in relative blood flow velocity in the posterior cerebral artery due to visual-cortical stimulation was higher in end diastolic values than peak systolic data. Using a complex visual stimulation paradigm, the higher sensitivity of the end diastolic index is of no practical use. Being less influenced by Doppler artefacts, the peak systolic velocity index is more feasible for control-system analysis of dynamic blood flow regulation.