脑血流和神经认知在经过过导管大动脉置换由于严重的大动脉狭窄症的患者中
Ronald M Lazar1,2, Terina Myers1, Toby I Gropen1
1Department of Neurology, University of Alabama at Birmingham, 1720 7th Avenue South, SC650K, Birmingham, AL 35294, USA.
European heart journal open
|January 4, 2024
概括
严重的大动脉狭窄 (AS) 并没有显著影响大脑血流 (CBF) 或认知. 过导管大动脉置换 (TAVR) 在AS患者中没有改善CBF或认知功能.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 医疗成像医学成像
背景情况:
- 大动脉狭窄 (AS) 会增加缩压,可能会影响心脏输出和大脑血液动力学.
- 在AS患者中,大脑血流 (CBF) 和神经认知以及门置换的效果仍未得到充分研究.
- 了解这些关联对于管理AS并发症至关重要.
研究的目的:
- 为了研究AS和改变的大脑血液动力学之间的关联.
- 为了确定AS是否与神经认知障碍有关.
- 评估跨导管大动脉置换 (TAVR) 对大脑血液动力学和认知功能的影响.
主要方法:
- 42名计划TAVR的患者接受了跨皮多普勒 (TCD) 测量中脑动脉平均流速 (MFVs).
- 一个神经认知电池评估了记忆,语言,注意力,视觉空间技能和执行功能,生成一个复合的Z分数.
- 测量是在TAVR前和TAVR后进行的 (平均随访时间为36天).
主要成果:
- 在TAVR前,平均MFV为42.36厘米/秒,平均认知Z-score为-0.22 SDs低于规范平均值.
- 在TAVR后,MFV没有显著变化 (P = 0.66).
- 在TAVR后的认知Z-score平均高于规范平均值的0.17SD,没有达到临床意义.
结论:
- 严重的AS在TCD上显示了最小的MFV损伤,与认知功能无关.
- 在这个队列中,TAVR并没有显著改变大脑血液动力学或认知表现.
- 该研究没有支持AS中CBF减少或TAVR后改善的假设.
相关概念视频
Blood Flow
Blood is pumped by the heart into the aorta, the largest artery in the body, and then into increasingly smaller arteries, arterioles, and capillaries. The velocity of blood flow decreases with increased cross-sectional blood vessel area. As blood returns to the heart through venules and veins, its velocity increases. The movement of blood is encouraged by smooth muscle in the vessel walls, the movement of skeletal muscle surrounding the vessels, and one-way valves that prevent backflow.
Autoregulation of Blood Flow
Autoregulation mechanisms are characterized by their inherent capacity for self-regulation without necessitating specific nervous stimulation or endocrine control. These mechanisms facilitate the adjustment of blood flow and, therefore, perfusion specific to each tissue region. This self-regulation encompasses chemical signals and myogenic controls.
Chemical Signaling in Autoregulation
Chemical signaling operates at the precapillary sphincter level, inciting either contraction or relaxation.
Chemical Signaling in Autoregulation
Chemical signaling operates at the precapillary sphincter level, inciting either contraction or relaxation.
The Arch of Aorta
The coronary arteries, originating from the ascending aorta, bifurcate from two sinuses located within the ascending aorta. Positioned just above the aortic semilunar valve, these sinuses house essential aortic baroreceptors and chemoreceptors, crucial for maintaining cardiac function. The left coronary artery and the right coronary artery branch off from the left posterior and anterior aortic sinuses, respectively.
Encircling the heart, the coronary arteries form a ring-like structure before...
Encircling the heart, the coronary arteries form a ring-like structure before...
Arteries of the Head and Neck
The human body's intricate network of arteries ensures that every organ system receives the necessary oxygen and nutrients for optimal function. The arterial network in the head and neck region is particularly complex, providing vital blood flow to the brain, eyes, and other critical structures. Prominent arteries in this region include the internal carotid arteries and the vertebral arteries.
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...


