Cerebral small vessel, but not large vessel disease, is associated with impaired cerebral autoregulation during cardiopulmonary bypass

A retrospective Cohort Study

Yohei Nomura, Roland Faegle, Daijiro Hori, Abbas Al-Qamari, Alexander J Nemeth, Rebecca Gottesman, Gayane Yenokyan, Charles Brown, Charles Wallace Hogue*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS: Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.86; P =.014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02-1.475; P =.029), but not moderate-severe large cerebral arterial stenosis (P =.406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21-8.71; P =.019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS: These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.

Original languageEnglish (US)
Pages (from-to)1314-1322
Number of pages9
JournalAnesthesia and analgesia
Volume127
Issue number6
DOIs
StatePublished - Jan 1 2018

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Cardiopulmonary Bypass
Homeostasis
Cohort Studies
Retrospective Studies
Cerebrovascular Circulation
Vascular Diseases
Pathologic Constriction
Cerebral Arteries
Odds Ratio
Magnetic Resonance Imaging
Brain
Confidence Intervals
Thoracic Surgery
Blood Vessels
Cerebral Arterial Diseases
Peripheral Vascular Diseases
Sex Ratio
Calcium Channel Blockers
Body Temperature
Hypotension

Keywords

  • Epigenomics
  • Genomics
  • Gut microbiome
  • Gut microbiota
  • Hypertension

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{52740babe1a24480a39edc59149d2d0d,
title = "Cerebral small vessel, but not large vessel disease, is associated with impaired cerebral autoregulation during cardiopulmonary bypass: A retrospective Cohort Study",
abstract = "BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. {"}Large vessel{"} cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. {"}Small vessel{"} cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS: Impaired autoregulation occurred in 32.4{\%} (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2{\%}) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95{\%} confidence interval [CI], 0.25-0.86; P =.014) and higher average temperature during CPB (OR, 1.23; 95{\%} CI, 1.02-1.475; P =.029), but not moderate-severe large cerebral arterial stenosis (P =.406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3{\%}) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95{\%} CI, 1.21-8.71; P =.019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS: These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.",
keywords = "Epigenomics, Genomics, Gut microbiome, Gut microbiota, Hypertension",
author = "Yohei Nomura and Roland Faegle and Daijiro Hori and Abbas Al-Qamari and Nemeth, {Alexander J} and Rebecca Gottesman and Gayane Yenokyan and Charles Brown and Hogue, {Charles Wallace}",
year = "2018",
month = "1",
day = "1",
doi = "10.1213/ANE.0000000000003384",
language = "English (US)",
volume = "127",
pages = "1314--1322",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

Cerebral small vessel, but not large vessel disease, is associated with impaired cerebral autoregulation during cardiopulmonary bypass : A retrospective Cohort Study. / Nomura, Yohei; Faegle, Roland; Hori, Daijiro; Al-Qamari, Abbas; Nemeth, Alexander J; Gottesman, Rebecca; Yenokyan, Gayane; Brown, Charles; Hogue, Charles Wallace.

In: Anesthesia and analgesia, Vol. 127, No. 6, 01.01.2018, p. 1314-1322.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cerebral small vessel, but not large vessel disease, is associated with impaired cerebral autoregulation during cardiopulmonary bypass

T2 - A retrospective Cohort Study

AU - Nomura, Yohei

AU - Faegle, Roland

AU - Hori, Daijiro

AU - Al-Qamari, Abbas

AU - Nemeth, Alexander J

AU - Gottesman, Rebecca

AU - Yenokyan, Gayane

AU - Brown, Charles

AU - Hogue, Charles Wallace

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS: Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.86; P =.014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02-1.475; P =.029), but not moderate-severe large cerebral arterial stenosis (P =.406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21-8.71; P =.019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS: These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.

AB - BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS: Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.86; P =.014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02-1.475; P =.029), but not moderate-severe large cerebral arterial stenosis (P =.406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21-8.71; P =.019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS: These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.

KW - Epigenomics

KW - Genomics

KW - Gut microbiome

KW - Gut microbiota

KW - Hypertension

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U2 - 10.1213/ANE.0000000000003384

DO - 10.1213/ANE.0000000000003384

M3 - Article

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SP - 1314

EP - 1322

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 6

ER -