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Link between cerebral blood flow and autonomic function in survivors of internal carotid artery occlusion
Ya-Ting Chang1, Wen-Neng Chang2, Nai-Wen Tsai2
1Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights
Symptomatic internal carotid artery occlusion (ICAO) survivors show persistent autonomic dysregulation, including reduced baroreflex sensitivity (BRS). Impaired cardio-vagal function and reduced BRS correlate with central autonomic network (CAN) activity, impacting long-term outcomes.
Area of Science:
- Neuroscience
- Cardiology
- Autonomic Nervous System Research
Background:
- Symptomatic internal carotid artery occlusion (ICAO) is a significant cause of cerebral ischemia with poor prognosis.
- Carotid atherosclerosis is linked to reduced baroreflex function and increased cardiovascular event risk.
- Forebrain regions modulate cardio-vagal and baroreflex functions, offering potential therapeutic targets.
Purpose of the Study:
- To investigate autonomic nervous system function in symptomatic ICAO survivors.
- To compare cardiovascular autonomic function and central autonomic network (CAN) activity between ICAO patients, small vessel disease (SVD) patients, and healthy controls.
- To explore the relationship between autonomic function parameters and recurrent cardiovascular events in ICAO survivors.
Main Methods:
- Enrolled 20 symptomatic ICAO survivors, 20 SVD patients, and 20 healthy controls.
- Assessed cardiovascular autonomic function including baroreflex sensitivity (BRS), Valsalva ratio (VR), and heart rate response to deep breathing (HR_DB).
- Utilized arterial spin-labeling MRI to measure regional cerebral blood flow (rCBF) in the CAN and correlated with autonomic parameters.
Main Results:
- ICAO survivors exhibited significantly lower VR and HR_DB compared to SVD patients and controls.
- Spontaneous BRS and BRS during Valsalva maneuver were significantly reduced in ICAO survivors and SVD patients versus controls.
- Reduced spontaneous BRS was inversely correlated with rCBF in the CAN.
Conclusions:
- Autonomic dysregulation, characterized by reduced BRS and impaired cardio-vagal function, persists in the convalescent stage of ICAO.
- Reduced BRS in ICAO is linked to altered central autonomic network activity.
- These findings highlight potential therapeutic targets for improving outcomes in ICAO patients.
Purpose:
Symptomatic internal carotid artery occlusion (ICAO) is an important cause of cerebral ischemia with poor long-term outcome. Reductions in baroreflex function is reported in carotid atherosclerosis and implicated in increased risk of recurrent cardiovascular events. A distributed network of forebrain regions can exert modulatory influences over the cardio-vagal and baroreflex functions. The successful clinical translation of these approaches offers insights into underlying modulatory mechanisms and to possible therapeutic strategy.
Methods:
This study enrolled 20 symptomatic ICAO survivors, 20 patients with small vessel disease (SVD) as risk control, and 20 healthy controls. All underwent a standardized evaluation of cardiovascular autonomic function testing that included baroreflex sensitivity (BRS), Valsalva ratio (VR), and heart rate response to deep breathing (HR_DB). The regional cerebral blood flow (rCBF) of the central autonomic network (CAN) was obtained from arterial spin-labeling magnetic resonance imaging. Parameters of autonomic function between symptomatic ICAO survivors with and those without recurrent cardiovascular events were compared.
Results:
Valsalva ratio and HR_DB levels were significantly higher in the control group, followed by the SVD and ICAO groups (p=0.009 and p=0.007, respectively). Spontaneous BRS and BRS during the early phase II of Valsalva maneuver levels were both significantly higher in the control group, followed by the SVD and ICAO groups (p<0.001 and p=0.042, respectively). The rCBF of CAN inversely correlated with spontaneous BRS.
Conclusion:
Autonomic dysregulation, including reduced BRS and impaired cardio-vagal function in the convalescent stage ICAO, can persist for a long time. Reduced BRS is inversely correlated with CAN activity.
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