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Published on: December 17, 2014
Identifying cardiovascular risk factors that impact cerebrovascular reactivity: An ASL MRI study
Salil Soman1, Weiying Dai2, Lucy Dong3
1The Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Cardiovascular risk factors like high blood pressure and prior stroke impact cerebral blood flow (CBF) regulation after carotid surgery. Understanding these factors is key for stroke risk management.
Area of Science:
- Neuroimaging
- Vascular Medicine
- Cardiology
Background:
- Cerebrovascular reactivity (CR) maintains cerebral blood flow (CBF) through vessel dilation/contraction.
- Cardiovascular (CV) disease elevates stroke risk, but its specific impact on CR remains unclear.
Purpose of the Study:
- To investigate how various cardiovascular risk factors influence CBF changes in patients undergoing carotid revascularization.
- To identify specific CV risk factors associated with altered cerebrovascular reactivity.
Main Methods:
- A prospective longitudinal study involving 53 subjects undergoing carotid endarterectomy or stenting.
- 3D pseudo-continuous arterial spin labeling (PCASL) and 3D fast spoiled gradient echo (FSPGR) MRI sequences were used for whole-brain CBF measurements at baseline, 48-hour post-op, and 6 months post-op.
- Statistical analysis included within-subject ANOVA and multiple linear regression, controlling for age, to correlate CV risk factors with CBF changes.
Main Results:
- Overall CBF increased post-surgery and decreased by 6 months, with no significant long-term change from baseline.
- Elevated systolic blood pressure (SBP), chronic renal insufficiency (CRI), and prior stroke (CVA) were associated with lower CBF increases from pre- to post-operation.
- Obesity and high cholesterol levels predicted greater CBF decrease from post-operation to 6 months.
Conclusions:
- Higher SBP, CRI, CVA, BMI, and cholesterol may indicate altered cerebrovascular reactivity.
- These findings suggest that specific CV risk factors necessitate tailored stroke risk mitigation strategies and careful evaluation of CBF changes.
Background:
To maintain cerebral blood flow (CBF), cerebral blood vessels dilate and contract in response to blood supply through cerebrovascular reactivity (CR).
Purpose:
Cardiovascular (CV) disease is associated with increased stroke risk, but which risk factors specifically impact CR is unknown.
Study Type:
Prospective longitudinal.
Subjects:
Fifty-three subjects undergoing carotid endarterectomy or stenting.
Field Strength/Sequence:
3T, 3D pseudo-continuous arterial spin labeling (PCASL) ASL, and T1 3D fast spoiled gradient echo (FSPGR).
Assessment:
We evaluated group differences in CBF changes for multiple cardiovascular risk factors in patients undergoing carotid revascularization surgery.
Statistical Tests:
PRE (baseline), POST (48-hour postop), and 6MO (6 months postop) whole-brain CBF measurements, as 129 CBF maps from 53 subjects were modeled as within-subject analysis of variance (ANOVA). To identify CV risk factors associated with CBF change, the CBF change from PRE to POST, POST to 6MO, and PRE to 6MO were modeled as multiple linear regression with each CV risk factor as an independent variable. Statistical models were performed controlling for age on a voxel-by-voxel basis using SPM8. Significant clusters were reported if familywise error (FWE)-corrected cluster-level was P < 0.05, while the voxel-level significance threshold was set for P < 0.001.
Results:
The entire group showed significant (cluster-level P < 0.001) CBF increase from PRE to POST, decrease from POST to 6MO, and no significant difference (all voxels with P > 0.001) from PRE to 6MO. Of multiple CV risk factors evaluated, only elevated systolic blood pressure (SBP, P = 0.001), chronic renal insufficiency (CRI, P = 0.026), and history of prior stroke (CVA, P < 0.001) predicted lower increases in CBF PRE to POST. Over POST to 6MO, obesity predicted lower (P > 0.001) and cholesterol greater CBF decrease (P > 0.001).
Data Conclusion:
The CV risk factors of higher SBP, CRI, CVA, BMI, and cholesterol may indicate altered CR, and may warrant different stroke risk mitigation and special consideration for CBF change evaluation.
Level Of Evidence:
1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:734-747.
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