Madsen Kristine Wichmann, Haahr Rasmus Primholdt, Mkhitarjan Tatevik, Wiinberg Niels, Marstrand Jacob Rørbech, Rosenbaum Sverre, Henriksen Alexander Cuculiza, Marner Lisbeth
Department of Neurology, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark.
Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark.
Clin Physiol Funct Imaging. 2025 Sep;45(5):e70029. doi: 10.1111/cpf.70029.
Hemodynamic failure in patients with steno-occlusive arterial disease is a major risk factor for stroke. Previous studies have identified impaired autonomic function in patients with carotid artery stenosis. Our study explores autonomic dysfunction and altered cerebrovascular hemodynamics in patients with stenosis and suspected hemodynamic failure.
To assess autonomic nervous system dysfunction, patients underwent heart rate variability (HRV) testing, an active stand test, and the Valsalva maneuver with simultaneous monitoring of heart rate, blood pressure, and cardiac output. Transcranial Doppler was used to measure relative changes in cerebral blood flow during Valsalva.
Analysis of 13 patients and 19 controls revealed a significantly greater decrease in cerebral blood flow in the patient group during Valsalva, as evidenced by mean relative changes in time-averaged peak velocities ±SE of 0.80 ± 0.04 in patients compared to 0.96 ± 0.05 in controls (p < 0.05). There were no significant differences in mean arterial blood pressure or heart rate during the Valsalva maneuver. HRV analysis and the active stand test did not reveal autonomic dysfunction or orthostatic intolerance.
Patients with steno-occlusive carotid artery disease exhibit impaired intracranial flow during Valsalva-induced blood pressure reduction. However, our results do not support the presence of significant autonomic dysfunction in patients with symptomatic large-vessel cerebrovascular disease as measured by HRV and blood pressure reduction during active stand.
狭窄闭塞性动脉疾病患者的血流动力学衰竭是中风的主要危险因素。先前的研究已确定颈动脉狭窄患者存在自主神经功能受损。我们的研究探讨了狭窄且疑似血流动力学衰竭患者的自主神经功能障碍和脑血管血流动力学改变。
为评估自主神经系统功能障碍，患者接受了心率变异性（HRV）测试、主动站立试验以及瓦尔萨尔瓦动作，同时监测心率、血压和心输出量。经颅多普勒用于测量瓦尔萨尔瓦动作期间脑血流的相对变化。
对13例患者和19例对照的分析显示，患者组在瓦尔萨尔瓦动作期间脑血流的下降明显更大，患者组时间平均峰值速度的平均相对变化±标准误为0.80±0.04，而对照组为0.96±0.05（p<0.05）。瓦尔萨尔瓦动作期间平均动脉血压或心率无显著差异。HRV分析和主动站立试验未显示自主神经功能障碍或体位性不耐受。
狭窄闭塞性颈动脉疾病患者在瓦尔萨尔瓦动作导致血压降低期间颅内血流受损。然而，我们的结果不支持通过HRV和主动站立期间的血压降低来衡量的有症状大血管脑血管疾病患者存在明显自主神经功能障碍。
