Cerebrovascular reactivity measured by functional magnetic resonance imaging during breath-hold challenge: A systematic review

Urback, Adam; MacIntosh, Bradley J.; Goldstein, Benjamin I.

doi:10.1016/j.neubiorev.2017.05.003

Cited by 69 publications

(91 citation statements)

References 87 publications

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“…The commonly used BHI outcome yielded a typical error expressed as a CV% of 16.2% for within-test reliability, in line with previously reported data (11.4%) in healthy adults. 27 Nevertheless, there are concerns with the application of the BHI 28 as the relationship between breath-hold length and the PaCO 2 stimulus remains unclear, with these data often not reported. 29,30 The BHI method was first employed to account for differences in breath-hold length and its pos- hold.…”

Section: Within-testmentioning

confidence: 99%

The reliability of a breath‐hold protocol to determine cerebrovascular reactivity in adolescents

Koep

Barker

Banks

et al. 2020

J of Clinical Ultrasound

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Purpose: Cerebrovascular reactivity (CVR) is impaired in adolescents with cardiovascular disease risk factors. A breath-hold test is a noninvasive method of assessing CVR, yet there are no reliability data of this outcome in youth. This study aimed to assess the reliability of a breath-hold protocol to measure CVR in adolescents. Methods: Twenty-one 13 to 15 year old adolescents visited the laboratory on two separate occasions, to assess the within-test, within-day and between-day reliability of a breath-hold protocol, consisting of three breath-hold attempts. CVR was defined as the relative increase from baseline in middle cerebral artery mean blood velocity following a maximal breath-hold of up to 30 seconds, quantified via transcranial Doppler ultrasonography. Results: Mean breath-hold duration and CVR were never significantly correlated (r < .31, P > .08). The within-test coefficient of variation for CVR was 15.2%, with no significant differences across breath-holds (P = .88), so the three breath-hold attempts were averaged for subsequent analyses. The within-and between-day coefficients of variation for CVR were 10.8% and 15.3%, respectively. Conclusions: CVR assessed via a three breath-hold protocol can be reliably measured in adolescents, yielding similar within-and between-day reliability. Analyses revealed that breath-hold length and CVR were unrelated, indicating the commonly reported normalization of CVR to breath-hold duration (breath-hold index) may be unnecessary in youth. K E Y W O R D S cerebral blood flow, endothelial function, hypercapnic stimulus, reproducibility, transcranial Doppler ultrasound, youth 1 | INTRODUCTION Cerebrovascular reactivity (CVR) refers to the ability of the human brain to modulate cerebral blood flow in response to changes in stimuli, such as the partial pressure of arterial carbon dioxide (PaCO 2). Impairments in CVR are an important hallmark for cerebrovascular disease (CVD) progression. Research highlights that impairments in CVR in adults is associated with Alzheimer's disease, 1 neurocognitive decline, 2 stroke, 3,4 and independently predicts future CVD events in patients with CVD risk factors. 5 Impairments in CVR are present in

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Section: Within-testmentioning

confidence: 99%

The reliability of a breath‐hold protocol to determine cerebrovascular reactivity in adolescents

Koep

Barker

Banks

et al. 2020

J of Clinical Ultrasound

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“…This is potentially important, given microvascular changes precede macrovascular ones . A recent systematic review identified 54 fMRI‐based CVR studies that used a breath‐hold task to induce hypercapnia . Advantages of fMRI, in comparison to other methods such as TCD, include superior spatial and temporal resolution, and whole‐brain imaging sensitive to microvascular signal.…”

Section: Introductionmentioning

confidence: 99%

“…While BH CVR has been shown to be an effective way to induce CVR, 28 there are alternative methods such as in evaluating signal fluctuation in resting state fMRI and evaluating CVR following CO 2 inhalation for example. 29,30 The purpose of this study is to compare CVR in adolescents with BD versus HCs.…”

Section: Introductionmentioning

confidence: 99%

Reduced cerebrovascular reactivity among adolescents with bipolar disorder

et al. 2018

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Objectives Cardiovascular disease (CVD) is excessive and premature among individuals with bipolar disorder (BD). Cerebrovascular reactivity (CVR), reflecting vasodilatory capacity of cerebral blood vessels in response to vasoactive substances, is a marker of cerebrovascular health. Despite informative findings in other diseases, CVR has not previously been examined in BD. Methods Twenty‐five adolescents with BD and 25 age and sex‐matched psychiatrically healthy controls (HCs) completed six 15‐second breath‐holds (BHs) during functional magnetic resonance imaging (fMRI) at 3‐Tesla. CVR was determined by comparing blood‐oxygenation‐level dependent (BOLD) signal changes. Voxel‐wise contrasts were analyzed. Body mass index (BMI) was examined as a potential confound. Results CVR in the posterior cingulate gyrus and periventricular white matter was lower in BD vs HC. After controlling for differences in BMI, additional between‐group CVR differences were observed in the temporal poles, supramarginal gyrus, and lingual gyrus. There were no regions in which CVR was significantly greater in BD vs HC. CVR was not associated with mood symptoms. Conclusions This preliminary study provides evidence of cerebrovascular dysfunction in BD, including regions known to be susceptible to cerebrovascular dysfunction and/or disease. These findings warrant additional research on the causes and consequences of cerebrovascular dysfunction in early‐onset BD.

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“…3 Previous MR imaging breath-hold experiments involved hy-percarbic air composition or the use of relatively short breathholds. 4 There are, however, crucial differences between experimental setups applying altered gas composition and those using voluntary breath-hold. In the latter, the human body can be examined as a closed system of internal metabolic gas exchange, while altered-ventilation gas studies are an "open system" approach with ventilation at variable frequencies as a complicating factor.…”

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confidence: 99%

Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers

Keil¹,

Eichhorn²,

Mutsaerts

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Experienced freedivers can endure prolonged breath-holds despite severe hypoxemia and are therefore ideal subjects to study apnea-induced cerebrovascular reactivity. This multiparametric study investigated CBF, the spatial coefficient of variation as a correlate of arterial transit time and brain metabolism, dynamics during prolonged apnea. MATERIALS AND METHODS: Fifteen male freedivers (age range, 20-64 years; cumulative previous prolonged breath-holds Ͼ2 minutes and 30 seconds: 4-79,200) underwent repetitive 3T pseudocontinuous arterial spin-labeling and 31 P-/ 1 H-MR spectroscopy before, during, and after a 5-minute breath-hold (split into early and late phases) and gave temporally matching venous blood gas samples. Correlation of temporal and regional cerebrovascular reactivity to blood gases and cumulative previous breath-holds of Ͼ2 minutes and 30 seconds in a lifetime was assessed. RESULTS: The spatial coefficient of variation of CBF (by arterial spin-labeling) decreased during the early breath-hold phase (Ϫ30.0%, P ϭ .002), whereas CBF remained almost stable during this phase and increased in the late phase (ϩ51.8%, P ϭ .001). CBF differed between the anterior and the posterior circulation during all phases (eg, during late breath-hold: MCA, 57.3 Ϯ 14.2 versus posterior cerebral artery, 42.7 Ϯ 10.8 mL/100 g/min; P ϭ .001). There was an association between breath-hold experience and lower CBF (1000 previous breath-holds reduced WM CBF by 0.6 mL/100 g/min; 95% CI, 0.15-1.1 mL/100 g/min; P ϭ .01). While breath-hold caused peripheral lactate rise (ϩ18.5%) and hypoxemia (oxygen saturation, Ϫ24.0%), cerebral lactate and adenosine diphosphate remained within physiologic ranges despite early signs of oxidative stress [Ϫ6.4% phosphocreatine / (adenosine triphosphate ϩ adenosine diphosphate); P ϭ .02]. CONCLUSIONS: This study revealed that the cerebral energy metabolism of trained freedivers withstands severe hypoxic hypercarbia in prolonged breath-hold due to a complex cerebrovascular hemodynamic response. ABBREVIATIONS: ATP ϭ adenosine triphosphate; ASL ϭ arterial spin-labeling; ASL-sCoV ϭ spatial coefficient of variation of CBF (by ASL); ATT ϭ arterial transit time; CVR ϭ cerebrovascular reactivity; HR ϭ heart rate; P i ϭ inorganic phosphates; PCr ϭ phosphocreatine; pO 2 ϭ partial pressure of oxygen; SpO 2 ϭ oxygen saturation

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Cerebrovascular reactivity measured by functional magnetic resonance imaging during breath-hold challenge: A systematic review

Cited by 69 publications

References 87 publications

The reliability of a breath‐hold protocol to determine cerebrovascular reactivity in adolescents

The reliability of a breath‐hold protocol to determine cerebrovascular reactivity in adolescents

Reduced cerebrovascular reactivity among adolescents with bipolar disorder

Cerebrovascular Reactivity during Prolonged Breath-Hold in Experienced Freedivers

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