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Published on: February 17, 2013
The Relationship Between Cerebral Perfusion, Blood Pressure Variability and 90-Day Prognosis in Patients with Acute
Jingyi Zhang1, Dan Zhu2, Meiru Chang1
1Nanjing University of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China.
Background And Purpose:
Research is still underway to determine the effect of blood pressure variability (BPV) on the prognosis of acute ischaemic stroke (AIS). The posterior circulation is vulnerable to BPV due to its unique anatomy. Our study systematically evaluated the effects of daily BPV and cerebral perfusion on 90-day prognosis of patients with acute posterior circulation cerebral infarction (PCCI) and further investigated their association.
Methods:
The study included 462 patients diagnosed with PCCI. Cerebral perfusion was assessed by F.MTT (focus mean transit time), rCBV (relative cerebral blood volume) and rCBF (relative cerebral blood flow). Blood pressure (BP) was recorded twice daily and the daily BPV was calculated with standard deviation (SD) and coefficient of variation (CV). Subsequently, the correlation between daily BPV, cerebral perfusion and 90-day prognosis was examined using logistic regression modelling. Potential non-linear relationships were assessed through the use of smooth curve fitting. Assessment to explore the relationship between cerebral perfusion levels and daily BPV using stepwise logistic regression analysis. Finally, mediation analysis was performed to test the relationship between CT perfusion (CTP) mediated BPV and 90-day adverse prognosis.
Results:
The study included 363 participants. Multivariate logistic regression analysis revealed that higher daily BPV and poorer cerebral perfusion were negatively associated with 90-day adverse prognosis in patients with PCCI (P < 0.05). In addition, poor cerebral perfusion was associated with higher daily BPV (MAP-SD: OR 1.15, 95% CI [1.03-1.27], P = 0.011; MAP-CV: OR 1.17, 95% CI [1.05 ~ 1.3], P = 0.004). Meanwhile, mediation analysis showed that rCBF mediated the association between daily BPV and 90-day adverse prognosis (indirect effect estimate = 0.918, direct effect estimate = 0.0621).
Conclusion:
Our study demonstrated that daily BPV and cerebral perfusion were positively associated with 90-day adverse prognosis in patients with PCCI, which was partly mediated by rCBF.
