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1 Geriatric Medicine, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
2 Presbyterian Hospital of Dallas, Dallas, Texas, United States
3 Exercise Physiology, IEEM, Dallas, Texas, United States
4 Medicine, University of Texas at Southwestern/IEEM, Dallas, Texas, United States
* To whom correspondence should be addressed. E-mail: rongzhang{at}texashealth.org.
Clinical TCD assessment of cerebral vasomotor reactivity (CVMR) uses linear regression of cerebral blood flow velocity (CBFV) versus end-tidal CO2 (PETCO2) under steady-state conditions. However, the CBF-PETCO2 relationship is nonlinear, even for moderate changes in CO2. Moreover, CBF is increased by increases in arterial blood pressure (ABP) during hypercapnia. We used a modified rebreathing protocol to estimate CVMR during breath-by-breath changes in PETCO2. Ten healthy subjects (6 men) performed 15 s of hyperventilation followed by 5 min of rebreathing, with supplemental O2 to maintain arterial oxygen saturation constant. To minimize effects of ABP on estimation of CVMR, cerebrovascular conductance index (CVCi) was calculated. The CBF/CVCi-PETCO2 relationships were quantified using both linear and logistic regression. In three subjects, muscle nerve sympathetic activity (MSNA) was recorded. Robust changes occurred in PETCO2 (20 to 61 mmHg), CBFV (-44 to +104 % of baseline), CVCi (-39 to +64 %) and ABP (-19 to +23 %), (all p < 0.01). MSNA increased by 446 % during hypercapnia. The linear slope of CVCi vs. PETCO2 was less steep than CBFV (3 vs. 5 %.mmHg-1, p = 0.01). Logistic regression of CBF-PETCO2 (r2, 0.97) and CVCi-PETCO2 (r2, 0.93) was superior to linear regression (r2, 0.91; r2, 0.85; p = 0.01). CVMR was maximal (6-8 % mmHg-1) in the range 40-50 mmHg PETCO2. Cerebrovascular responses to changes in PETCO2 can be described by a logistic function. Quantification of the CVCi-PETCO2 relationship minimizes effects of ABP on the estimation of CVMR.
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