Arterial Stiffening Contributes to Impairment of Cerebrovascular Reactivity in Patients With Coronary Artery Disease Without Carotid Stenosis

Abstract

Impaired cerebrovascular reactivity (CVR), an important risk factor for future stroke, is affected by a presence carotid stenosis. However, in some cases CVR can be impaired in the absence of carotid stenosis due to several poorly characterized mechanisms. We hypothesized that arterial stiffening as observed in coronary heart disease (CHD) could be associated with alteration in CVR in CHD patients without carotid stenosis. The study population consisted of patients referred for coronary angiography without significant carotid stenosis (<50 %). CVR was evaluated by breath holding index (BHI) measured with transcranial color code duplex ultrasound. Arterial stiffness was assessed by pulse wave velocity (PWV) measured by the oscillometric method. The extent of coronary atherosclerosis was quantified by Gensini score (GS). Out of 186 subjects, sixty-two patients fulfilled the inclusion and exclusion criteria. BHI decreased with increasing PWV (r = –0.47, p<0.001). Decrease in BHI was significantly inversely associated with GS (r = –0.61, p<0.001). GS was associated with PWV (p<0.001). In conclusion, impaired CVR was associated with increased arterial stiffening in CHD patients in the absence of significant carotid stenosis. Thus, we speculate that increased arterial stiffness may at least partially contribute to the pathophysiology of CVR alteration in coronary artery disease.

Young smoker “ABCD” vascular assessment: a four-step ultrasound examination for detecting peripheral, extra and intra-cranial early arterial damage

“…The association between altered cerebrovascular reactivity and the degree of coronary atherosclerosis has been found [ 41 ] and it was confirmed also in patients without carotid stenosis [ 14 ], so the link between CAD and cerebrovascular functional impairment has been supported.…”

“…Moreover, if a significant carotid stenosis or occlusion is considered as one of the most important factors affecting cerebral vasomotor reactivity, very recently an association between altered reactivity and CAD has been established, even in the absence of significant carotid stenosis [ 14 ].…”

The Impact of Remote Ischemic Preconditioning on Arterial Stiffness and Heart Rate Variability in Patients with Angina Pectoris

“…RIPC effects are surely mediated by endothelium [ 25 ] by means of sympathetic and parasympathtic nervous systems and vascular and tissue agents [ 18 , 26 ]. The procedure effect is partly explained by the endothelium dysfunction improvement [ 4 , 19 , 20 , 21 ], which accompanies CHD, which in turn is associated with the rise of central blood pressure and vascular wall stiffness [ 27 , 28 ]. Taking into account local and general afferent and efferent sympathic and parasympathic neural pathways in RIPC, the effect on the autonomic nervous system heart rate control has also been proposed.…”

Blood Pressure and All‐Cause Mortality by Level of Cognitive Function in the Elderly: Results From a Population‐Based Study in Rural Greece

“…Although loss of cerebral autoregulation has been systematically described in animal models of Alzheimer's disease, the evidence in humans is not robust . Patients with cognitive impairment in this sample were also characterized by increased PP values, indicating potentially advanced arterial stiffness, which has also been found to contribute to the loss of cerebral vasomotor reactivity . If this explanation is true, presence of dementia could indicate susceptibility to hypoperfusion and ischemic changes or uncontrolled flow and hemorrhagic injuries in the cerebral arteriolar bed caused by extremely low or high SBP and MAP values, respectively, especially under presence of arterial stiffness .…”

“…[38][39][40] Patients with cognitive impairment in this sample were also characterized by increased PP values, indicating potentially advanced arterial stiffness, which has also been found to contribute to the loss of cerebral vasomotor reactivity. 41 If this explanation is true, presence of dementia could indicate susceptibility to hypoperfusion and ischemic changes or uncontrolled flow and hemorrhagic injuries in the cerebral arteriolar bed caused by extremely low or high SBP and MAP values, respectively, especially under presence of arterial stiffness. [42][43][44] It should be take into account, however, that patients with cognitive impairment who receive suboptimal care are also at higher risk for noncompliance to antihypertensive treatment, 45 thus increasing their vulnerability to the negative effects of hypertension.…”