Assessment of cerebral blood flow in adult patients with aortic coarctation

Wong, Rachel H. X.; Ahmad, Waheed; Davies, Allan; Spratt, Neil J; Boyle, Andrew; Levi, Christopher; Howe, Peter; Collins, Nicholas

doi:10.1017/s1047951117000920

Cited by 13 publications

(16 citation statements)

References 33 publications

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“…Impaired cerebral blood flow response to cognitive stimulus has also been associated with abnormal gait patterns, in keeping with differences in gait speed observed between the two cohorts . Our previous cross‐sectional comparison between patients with previous surgical repair of aortic coarctation and controls has shown impairment of CVR, reflecting abnormal cerebral blood flow . The detection of cognitive dysfunction and accompanying perturbations in cerebral blood flow is an important insight into the late morbidity associated with single ventricular physiology.…”

Section: Discussionsupporting

confidence: 67%

“…The development of atherosclerotic disease is now recognized to progress from childhood, with ultrasound measures to assess vascular function identified as an important modality . Abnormal carotid artery resistance is associated with increased stroke risk; transcranial Doppler techniques have identified abnormal resistance in cerebral arteries in patients with diabetes, a group prone to adverse cerebral vascular events, as well as in adult patients with a background of aortic coarctation repair, similarly documented to be at risk of adverse cerebral events . This study demonstrates that similar abnormalities of measures of vascular resistance are seen in patients with single ventricular physiology.…”

Section: Discussionmentioning

confidence: 57%

“…Basal cerebral hemodynamics included pulsatility and resistive indices of the middle cerebral arteries which reflect the degree of arterial stiffness; previous studies have demonstrated these measures to be abnormal in patients with aortic coarctation, with deficits similar to those seen in patients with established vascular disease …”

Section: Methodsmentioning

confidence: 99%

“…11 Our previous cross-sectional comparison between patients with previous surgical repair of aortic coarctation and controls has shown impairment of CVR, reflecting abnormal cerebral blood flow. 6 The detection of cognitive dysfunction and accompanying perturbations in cerebral blood flow is an important insight into the late morbidity associated with single ventricular physiology.…”

Section: Re Sultsmentioning

confidence: 99%

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Cognitive dysfunction is associated with abnormal responses in cerebral blood flow in patients with single ventricular physiology: Novel insights from transcranial Doppler ultrasound

Wong

Al-Omary

Baker

et al. 2019

Congenital Heart Disease

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Objectives Improvements in the management of complex congenital heart disease, including those with single ventricle physiology, have resulted in increased survival. As this population ages, the recognition of cognitive impairment is increasingly important. At present, little is known about the potential mechanisms of cognitive dysfunction. In this cross‐sectional study, we aimed to characterize the nature of abnormalities in cerebral blood flow and the relationship to cognitive deficits in adults with single ventricular physiology. Patients Ten adults with single ventricular physiology (age 18‐40 years) and 12 age‐ and gender‐matched controls underwent transcranial Doppler ultrasound and accompanying cognitive assessment. Outcome Measures Patients underwent neuropsychological testing that assessed differing cognitive domains, with subjective cognitive decline determined from a 24‐question survey. Transcranial Doppler ultrasound was used to assess baseline cerebral blood flow as well as change in cerebral blood flow velocities from baseline and during cognitive testing. Age, ethnicity, individual, and parental education levels were considered in the multivariate analyses. Results On assessment of cognitive function, the patient group performed more poorly across each of the measured domains. The control group had a significantly greater increase in cerebral blood flow in response to cognitive stimuli compared to the patient cohort; these differences in response to cognitive stimuli were seen to a similar extent across each of the measured cognitive domains. Conclusion Adults with Fontan physiology are underperforming in assessments of executive function with associated abnormalities in cerebral perfusion potentially contributing to cognitive deficits.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 57%

Section: Methodsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

See 2 more Smart Citations

Cognitive dysfunction is associated with abnormal responses in cerebral blood flow in patients with single ventricular physiology: Novel insights from transcranial Doppler ultrasound

Wong

Al-Omary

Baker

et al. 2019

Congenital Heart Disease

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“…84 Furthermore, in patients with repaired aortic coarctation, in whom only pulse pressure was significantly elevated, the flow velocity increase produced by photic stimulation in the posterior cerebral artery, which supplies the visual cortex, was suppressed. 85 Consistent with altered neurovascular coupling, the increase in retinal blood flow induced by light flickering was absent in individuals with hypertension. 86 These findings, albeit limited, support the view that neurovascular uncoupling may compromise substrate delivery to the brain and render the brain more vulnerable to vascular insufficiency.…”

Section: Neurovascular Coupling and Endothelial Regulationmentioning

confidence: 93%

Neurovascular and Cognitive Dysfunction in Hypertension

Iadecola

Gottesman

2019

Circulation Research

349

316

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Hypertension has emerged as a leading cause of age-related cognitive impairment. Long known to be associated with dementia caused by vascular factors, hypertension has more recently been linked also to Alzheimer's disease, the major cause of dementia in older people. Thus, while midlife hypertension is a risk factor for late-life dementia, hypertension may also promote the neurodegenerative pathology underlying Alzheimer's disease. The mechanistic bases of these harmful effects remain to be established. Hypertension is well known to alter in the structure and function of cerebral blood vessels, but how these cerebrovascular effects lead to cognitive impairment and promote Alzheimer disease pathology is not well understood. Furthermore, critical questions also concern whether treatment of hypertension prevents cognitive impairment, the blood pressure threshold for treatment, and the anti-hypertensive agents to be used. Recent advances in neurovascular biology, epidemiology, brain imaging, and biomarker development have started to provide new insights into these critical issues. In this review, we will examine the progress made to date and, after a critical evaluation of the evidence, we will highlight questions still outstanding and seek to provide a path forward for future studies.

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