Impaired cerebrovascular reactivity in chronic obstructive pulmonary disease
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Impaired cerebrovascular reactivity (CVR) is associated with stroke. Cerebrovascular diseases are common comorbidity in chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to quantify CVR in the anterior and posterior cerebral circulation during voluntary breath-holding in COPD patients according to airflow limitation severity. In this cross-sectional study, we compared 90 COPD patients without previous cerebrovascular disease and 30 age- and sex-matched healthy volunteers (mean age 67 ± 7.9, 87 males). Using transcranial Doppler ultrasound and breath-holding index (BHI), we analysed baseline mean flow velocities (MFV) and CVR of middle cerebral artery (MCA) and basilar artery (BA). Our results demonstrated that COPD patients had lower baseline MFV of both MCA and BA than controls. COPD patients had significantly lower BHImMCA and BHImBA than controls (0.8 and 0.7 versus 1.24 and 1.07, respectively; p < 0.001). With the severity of airflow obstruction, there were significant declines of BHImMCA and BHImBA in mild (0.94 and 0.83), moderate (0.8 and 0.7) and severe to very severe COPD (0.7 and 0.6), respectively (p < 0.001). For all participants, we found a significant and positive correlation between forced expiratory volume in one second (FEV1) and BHImMCA (Rho = 0.761, p < 0.001) and between FEV1 and BHImBA (Rho = 0.409, p < 0.001). COPD patients have impaired CVR in anterior and posterior cerebral circulation. Impairment of CVR increase with the airflow limitation severity. CVR is an appropriate marker to identify vulnerable COPD subjects at high risk to develop cerebrovascular disease. Prospective studies are needed for further evaluation.
KeywordsCerebrovascular reactivity Chronic obstructive pulmonary disease Transcranial Doppler ultrasound Breath-holding index
We gratefully acknowledge the time and effort of our research participants.
M. Hlavati designed the study, performed the assessments and participant examinations. KB and ST performed the data collection. M. Hlavati, KB, ST and M. Horvat performed the data analysis and interpretation. SBS supervised the measurements. All authors contributed to data interpretation and to the writing of the manuscript. All authors have read and approved the final version of the manuscript.
The study was not funded.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval and consent to participate
The study was approved by the ethics committee of General Hospital Našice (No. 01-497/3-2017) and by ethics committee Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Croatia (No. 2158-61-07-17-209). All data were anonymized and the study was conducted in accordance with the amended Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. All participants signed an informed consent form before entering the study.
Availability of data and materials
The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.
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