Middle cerebral artery resistivity and pulsatility indices in systemic lupus erythematosus: evidence for hyperperfusion

Abstract

Background and purpose Systemic lupus erythematosus (SLE) is associated with significant cerebrovascular and neuropsychiatric disease for which multiple pathogeneses have been proposed. Although global cerebral hypoperfusion has been proposed, there are limited data about intracerebral arterial hemodynamics. Transcranial Doppler (TCD) allows portable, high temporal and spatial resolution, noninvasive blood velocity measurements in the middle cerebral arteries, and calculations of standard resistivity (RI) and pulsatility (PI) indices. RI and PI correlate with cerebral hemispheric arteriolar tone, blood flow resistances, and impedances. Accordingly, we hypothesized that there would be significant differences (p<0.05) in RI and PI between SLE patients and healthy, age and gender matched controls. Methods TCD was used to measure RI and PI bilaterally on 34 stable SLE patients (35±11 years) and 15 control subjects (34±10 years). Patients and controls had similar, normal blood pressures and were examined in the supine position during normal, resting respiration. RI and PI were determined by a blinded, experienced observer. Results There were no significant differences in RI and PI bilaterally within each cohort. However, SLE patients had significantly lower average RI and PI values compared with controls: 0.45±0.10 versus 0.52±0.05 (p<0.05); and 0.65±0.19 versus 0.77±0.12, (p<0.05); respectively. Conclusions These preliminary data suggest that RI and PI values in the human middle cerebral artery are significantly lower in SLE compared with controls. These indices indicate that middle cerebral arterial resistances and impedances are decreased in SLE. Under normotensive conditions, the results are consistent with hyperperfusion in SLE with increased arteriolar dilation and increased cerebral blood flow.

Cerebral microvascular and microstructural integrity is regionally altered in patients with systemic lupus erythematosus

“…Investigations of cerebral blood flow using MRI methods such as arterial spin labeling [9] and dynamic susceptibility contrast [23], or radioactive tracer methods such as single photon emission computed tomography (SPECT) [24] have shown inconsistent results for SLE. While some studies have reported cerebral hypoperfusion with SLE [9,24,25], others reported that SLE patients have increased regional cerebral blood flow compared to controls [10,23,26,27]. The cSLEassociated increase in the blood flow-related product D * × v bw found in posterior brain regions in this study supports hyperperfusion, at least in the absence of clinically relevant neurocognitive deficits.…”

Subclinical right ventricle systolic dysfunction in childhood-onset systemic lupus erythematosus: insights from two-dimensional speckle-tracking echocardiography

“…Similarly, cerebral microvascular occlusion attributed to antiphospholipid antibodies is one of the physiopathological mechanisms implicated in neuropsychiatric manifestations of SLE patients. 35 The assessment of RV function is of paramount importance in many cardiovascular and pulmonary diseases. 36 Indeed, worse RV systolic strain provides prognostic value incremental to LV ejection fraction in a variety of cardiomyopathies.…”

“…Similarly, cerebral microvascular occlusion attributed to antiphospholipid antibodies is one of the physiopathological mechanisms implicated in neuropsychiatric manifestations of SLE patients. 35…”

Physical Therapy Combined with Corticosteroid Intervention for Systemic Lupus Erythematosus with Central Nervous System Involvement: A Case Report

“…Systemic lupus erythematosus (SLE) is associated with significant cerebrovascular and neuropsychiatric diseases for which multiple pathogeneses have been proposed 1 ) . Involvement of the central nervous system (CNS) is one of the major causes of mortality and morbidity in SLE patients 2 ) .…”

“…Cerebrovascular diseases in SLE have been estimated to occur in 5 to 19.6% of SLE patients 4 ) . SLE patients with CNS involvement can demonstrate stroke-like symptoms such as severe hemiparesis, spasticity, loss of soft tissue elasticity, etc 1 , 5 ) .…”