Cerebrovascular reactivity assessment with O2-CO2 exchange ratio under brief breath hold challenge.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Brain*/blood supply ; Brain*/diagnostic imaging ; Brain*/metabolism ; Breath Holding* ; Cerebrovascular Circulation* ; Hypercapnia*/blood ; Hypercapnia*/diagnostic imaging ; Magnetic Resonance Imaging* ; Ultrasonography, Doppler, Transcranial*; Carbon Dioxide/*blood ; Oxygen/*blood; Adult ; Female ; Humans ; Male ; Middle Aged ; Partial Pressure
    • Abstract:
      Background: Hypercapnia during breath holding is believed to be the dominant driver behind the modulation of cerebral blood flow (CBF). However, increasing evidence show that mild hypoxia and mild hypercapnia in breath hold (BH) could work synergistically to enhance CBF response. We hypothesized that breath-by-breath O2-CO2 exchange ratio (bER), defined as the ratio of the change in partial pressure of oxygen (ΔPO2) to that of carbon dioxide (ΔPCO2) between end inspiration and end expiration, would be able to better correlate with the global and regional cerebral hemodynamic responses (CHR) to BH challenge. We aimed to investigate whether bER is a more useful index than end-tidal PCO2 to characterize cerebrovascular reactivity (CVR) under BH challenge.
      Methods: We used transcranial Doppler ultrasound (TCD) to evaluate CHR under BH challenge by measuring cerebral blood flow velocity (CBFv) in the middle cerebral arteries. Regional changes in CHR to BH and exogenous CO2 challenges were mapped with blood oxygenation level dependent (BOLD) signal changes using functional magnetic resonance imaging (fMRI). We correlated respiratory gas exchange (RGE) metrics (bER, ΔPO2, ΔPCO2, end-tidal PCO2 and PO2, and time of breaths) with CHR (CBFv and BOLD) to BH challenge. Temporal features and frequency characteristics of RGE metrics and their coherence with CHR were examined.
      Results: CHR to brief BH epochs and free breathing were coupled with both ΔPO2 and ΔPCO2. We found that bER was superior to either ΔPO2 or ΔPCO2 alone in coupling with the changes of CBFv and BOLD signals under breath hold challenge. The regional CVR results derived by regressing BOLD signal changes on bER under BH challenge resembled those derived by regressing BOLD signal changes on end-tidal PCO2 under exogenous CO2 challenge.
      Conclusion: Our findings provide a novel insight on the potential of using bER to better quantify CVR changes under BH challenge.
      Competing Interests: The authors have declared that no competing interests exist.
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    • Grant Information:
      P41 EB015896 United States EB NIBIB NIH HHS; S10 RR023043 United States RR NCRR NIH HHS; K23 MH086619 United States MH NIMH NIH HHS
    • Accession Number:
      142M471B3J (Carbon Dioxide)
      S88TT14065 (Oxygen)
    • Publication Date:
      Date Created: 20200326 Date Completed: 20200514 Latest Revision: 20200514
    • Publication Date:
      20240105
    • Accession Number:
      PMC7092994
    • Accession Number:
      10.1371/journal.pone.0225915
    • Accession Number:
      32208415