TY - JOUR
T1 - Transcranial Doppler cerebrovascular reactivity
T2 - Thresholds for clinical significance in cerebrovascular disease
AU - Regenhardt, Robert W.
AU - Nolan, Neal M.
AU - Das, Alvin S.
AU - Mahajan, Rahul
AU - Monk, Andrew D.
AU - LaRose, Sarah L.
AU - Migdady, Ibrahim
AU - Chen, Yimin
AU - Sheriff, Faheem
AU - Bai, Xuesong
AU - Dmytriw, Adam A.
AU - Patel, Aman B.
AU - Snider, Samuel B.
AU - Vaitkevicius, Henrikas
N1 - Publisher Copyright:
© 2024 American Society of Neuroimaging.
PY - 2024
Y1 - 2024
N2 - Background and Purpose: Thresholds for abnormal transcranial Doppler cerebrovascular reactivity (CVR) studies are poorly understood, especially for patients with cerebrovascular disease. Using a real-world cohort with cerebral arterial stenosis, we sought to describe a clinically significant threshold for carbon dioxide reactivity (CO2R) and vasomotor range (VMR). Methods: CVR studies were performed during conditions of breathing room air normally, breathing 8% carbon dioxide air mixture, and hyperventilation. The mean and standard deviation (SD) of CO2R and VMR were calculated for the unaffected side in patients with unilateral stenosis; a deviation of 2 SDs below the mean was chosen as the threshold for abnormal. Receiver operating characteristic (ROC) curves for both sides for patients with unilateral and bilateral stenosis were evaluated for sensitivity (Sn) and specificity (Sp). Results: A total of 133 consecutive CVR studies were performed on 62 patients with stenosis with mean±SD age 55±16 years. Comorbidities included hypertension (60%), diabetes (15%), stroke (40%), and smoking (35%). In patients with unilateral stenosis, mean±SD CO2R for the unaffected side was 1.86±0.53%, defining abnormal CO2R as <0.80%. Mean±SD CO2R for the affected side was 1.27±0.90%. The CO2R threshold predicted abnormal acetazolamide single-photon emission computed tomography (SPECT) (Sn =.73, Sp =.79), CT/MRI perfusion abnormality (Sn =.42, Sp =.77), infarction on MRI (Sn =.45, Sp =.76), and pressure-dependent exam (Sn =.50, Sp =.76). For the unaffected side, mean±SD VMR was 39.5±15.8%, defining abnormal VMR as <7.9%. For the affected side, mean±SD VMR was 26.5±17.8%. The VMR threshold predicted abnormal acetazolamide SPECT (Sn =.46, Sp =.94), infarction on MRI (Sn =.27, Sp =.94), and pressure-dependent exam (Sn =.31, Sp =.90). Conclusions: In patients with multiple vascular risk factors, a reasonable threshold for clinically significant abnormal CO2R is <0.80% and VMR is <7.9%. Noninvasive CVR may aid in diagnosing and risk stratifying patients with stenosis.
AB - Background and Purpose: Thresholds for abnormal transcranial Doppler cerebrovascular reactivity (CVR) studies are poorly understood, especially for patients with cerebrovascular disease. Using a real-world cohort with cerebral arterial stenosis, we sought to describe a clinically significant threshold for carbon dioxide reactivity (CO2R) and vasomotor range (VMR). Methods: CVR studies were performed during conditions of breathing room air normally, breathing 8% carbon dioxide air mixture, and hyperventilation. The mean and standard deviation (SD) of CO2R and VMR were calculated for the unaffected side in patients with unilateral stenosis; a deviation of 2 SDs below the mean was chosen as the threshold for abnormal. Receiver operating characteristic (ROC) curves for both sides for patients with unilateral and bilateral stenosis were evaluated for sensitivity (Sn) and specificity (Sp). Results: A total of 133 consecutive CVR studies were performed on 62 patients with stenosis with mean±SD age 55±16 years. Comorbidities included hypertension (60%), diabetes (15%), stroke (40%), and smoking (35%). In patients with unilateral stenosis, mean±SD CO2R for the unaffected side was 1.86±0.53%, defining abnormal CO2R as <0.80%. Mean±SD CO2R for the affected side was 1.27±0.90%. The CO2R threshold predicted abnormal acetazolamide single-photon emission computed tomography (SPECT) (Sn =.73, Sp =.79), CT/MRI perfusion abnormality (Sn =.42, Sp =.77), infarction on MRI (Sn =.45, Sp =.76), and pressure-dependent exam (Sn =.50, Sp =.76). For the unaffected side, mean±SD VMR was 39.5±15.8%, defining abnormal VMR as <7.9%. For the affected side, mean±SD VMR was 26.5±17.8%. The VMR threshold predicted abnormal acetazolamide SPECT (Sn =.46, Sp =.94), infarction on MRI (Sn =.27, Sp =.94), and pressure-dependent exam (Sn =.31, Sp =.90). Conclusions: In patients with multiple vascular risk factors, a reasonable threshold for clinically significant abnormal CO2R is <0.80% and VMR is <7.9%. Noninvasive CVR may aid in diagnosing and risk stratifying patients with stenosis.
KW - CO2 reactivity
KW - arterial stenosis
KW - cerebrovascular disease
KW - cerebrovascular reactivity
KW - ischemic stroke
KW - transcranial Doppler
KW - vasomotor range
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U2 - 10.1111/jon.13197
DO - 10.1111/jon.13197
M3 - Article
C2 - 38553906
AN - SCOPUS:85189614675
SN - 1051-2284
JO - Journal of Neuroimaging
JF - Journal of Neuroimaging
ER -