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Division of Medical Physics, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW; and Division of Medicine for the Elderly, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
The influence of different
types of maneuvers that can induce sudden changes of arterial blood
pressure (ABP) on the cerebral blood flow velocity (CBFV) response was
studied in 56 normal subjects (mean age 62 yr, range 23-80). ABP
was recorded in the finger with a Finapres device, and bilateral
recordings of CBFV were performed with Doppler ultrasound of the middle
cerebral arteries. Recordings were performed at rest (baseline) and
during the thigh cuff test, lower body negative pressure, cold pressor
test, hand grip, and Valsalva maneuver. From baseline recordings,
positive and negative spontaneous transients were also selected.
Stability of PCO2 was monitored with
transcutaneous measurements. Dynamic autoregulatory index (ARI),
impulse, and step responses were obtained for 1-min segments of data
for the eight conditions by fitting a mathematical model to the
ABP-CBFV baseline and transient data (Aaslid's model) and by the
Wiener-Laguerre moving-average method. Impulse responses were similar
for the right- and left-side recordings, and their temporal pattern was
not influenced by type of maneuver. Step responses showed a sudden rise
at time 0 and then started to fall back to their original
level, indicating an active autoregulation. ARI was also independent of
the type of maneuver, giving an overall mean of 4.7 ± 2.9 (n = 602 recordings). Amplitudes of the impulse and
step responses, however, were significantly influenced by type of
maneuver and were highly correlated with the resistance-area product
before the sudden change in ABP (r = 
0.93,
P < 0.0004). These results suggest that amplitude of
the CBFV step response is sensitive to the point of operation of the
instantaneous ABP-CBFV relationship, which can be shifted by different
maneuvers. Various degrees of sympathetic nervous system activation
resulting from different ABP-stimulating maneuvers were not reflected
by CBFV dynamic autoregulatory responses within the physiological range of ABP.
cerebral circulation; cerebrovascular resistance; cerebral autoregulation; thigh cuff test; cold pressor test; hand grip; Valsalva maneuver
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