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Retrograde blood flow in the internal jugular veins of humans with hypertension may have implications for cerebral arterial blood flow

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To use multi-parametric magnetic resonance imaging (MRI) to test the hypothesis that hypertensives would have higher retrograde venous blood flow (RVBF) in the internal jugular veins (IJV) vs. normotensives, and that this would inversely correlate with arterial inflow and gray matter, white matter, and cerebrospinal fluid volumes.

Methods

Following local institutional review board approval and written consent, a prospective observational 3-T MRI study of 42 hypertensive patients (53 ± 2 years, BMI 28.2 ± 0.6 kg/m2, ambulatory daytime systolic BP 148 ± 2 mmHg, ambulatory daytime diastolic BP 101 ± 2 mmHg) and 35 normotensive patients (48 ± 2 years, BMI 25.2 ± 0.8 kg/m2, ambulatory daytime systolic BP 119 ± 3 mmHg, ambulatory daytime diastolic BP 90 ± 2 mmHg) was performed. Phase contrast imaging calculated percentage retrograde venous blood flow (%RVBF), brain segmentation estimated regional brain volumes from 3D T1-weighted images, and pseudo-continuous arterial spin labeling measured regional cerebral blood perfusion. Statistical analysis included two-sample equal variance Student’s T tests, two-way analysis of variance with Tukey’s post hoc correction, and permutation-based two-group general linear modeling (p < 0.05).

Results

In the left IJV, %RVBF was higher in hypertensives (6.1 ± 1.5%) vs. normotensives (1.1 ± 0.3%, p = 0.003). In hypertensives, there was an inverse relationship of %RVBF (permutation-based general linear modeling) to cerebral blood flow in several brain regions, including the left occipital pole and the cerebellar vermis (p < 0.01). Percentage retrograde flow in the left IJV correlated inversely with the total matter volume (gray plus white matter volume) in hypertensives (r = − 0.49, p = 0.004).

Conclusion

RVBF in the left IJV is greater in hypertensives vs. normotensives and is linked to regional hypoperfusion and brain total matter volume.

Key Points

• Hypertensive humans have higher retrograde cerebral venous blood flow, associated with regional brain hypoperfusion and lower tissue volume, compared with controls.

• Cerebral retrograde venous blood flow may add further stress to already hypoperfused tissue in hypertensive patients.

• The amount of retrograde venous blood flow in hypertensive patients may predict which patients might be at higher risk of developing cerebral pathologies.

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Abbreviations

BP:

Blood pressure

CSA:

Cross-sectional area

CSF:

Cerebrospinal fluid

IJV:

Internal jugular vein

MRI:

Magnetic resonance imaging

PCASL:

Pseudo-continuous arterial spin labeling

ROI:

Region of interest

RVBF:

Retrograde venous blood flow

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Acknowledgments

The authors would like to thank Peter Hobden, Martin Stuart, and John Evans for their help in designing MR paradigms and acquiring the MR images. We would also like to thank the research nurses Rissa Calsena and Jenny Wilcox for their help in recruiting and screening the participants. Finally, we would like to thank the volunteers for participating in this study.

Funding

The study was funded by the British Heart Foundation (IBSRF FS/11/1/28400; ECH).

Author information

Authors and Affiliations

  1. BHI CardioNomics Research Group, Clinical Research and Imaging Centre-Bristol, School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, BS8 1TD, UK

    Jonathan C. L. Rodrigues, Galina Strelko, Sandra Neumann, Laura E. K. Ratcliffe, Benjamin Chant, Ruth Bowles, Julian F. R. Paton & Emma C. Hart

  2. Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, Avon, BA1 3NG, UK

    Jonathan C. L. Rodrigues

  3. Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands

    Esther A. H. Warnert

  4. BHI CardioNomics Research Group, Clinical Research and Imaging Centre-Bristol, School of Clinical Sciences, University of Bristol, Bristol, BS8 1TD, UK

    Amy E. Burchell & Angus K. Nightingale

  5. Department of Radiology, CAIR Program, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada

    Ashley D. Harris

  6. School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, CF10 3AT, UK

    Richard G. Wise

Authors
  1. Jonathan C. L. Rodrigues
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Corresponding author

Correspondence to Emma C. Hart.

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The scientific guarantor of this publication is Dr. Emma Hart.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Written informed consent was obtained from all subjects (patients) in this study.

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Rodrigues, J.C.L., Strelko, G., Warnert, E.A.H. et al. Retrograde blood flow in the internal jugular veins of humans with hypertension may have implications for cerebral arterial blood flow. Eur Radiol 30, 3890–3899 (2020). https://doi.org/10.1007/s00330-020-06752-6

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  • DOI: https://doi.org/10.1007/s00330-020-06752-6

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