Document Detail


Cerebrovascular reserve capacity is impaired in patients with sickle cell disease.
MedLine Citation:
PMID:  19700663     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Sickle cell disease (SCD) is associated with a high incidence of ischemic stroke. SCD is characterized by hemolytic anemia, resulting in reduced nitric oxide-bioavailability, and by impaired cerebrovascular hemodynamics. Cerebrovascular CO2 responsiveness is nitric oxide dependent and has been related to an increased stroke risk in microvascular diseases. We questioned whether cerebrovascular CO2 responsiveness is impaired in SCD and related to hemolytic anemia. Transcranial Doppler-determined mean cerebral blood flow velocity (V(mean)), near-infrared spectroscopy-determined cerebral oxygenation, and end-tidal CO2 tension were monitored during normocapnia and hypercapnia in 23 patients and 16 control subjects. Cerebrovascular CO2 responsiveness was quantified as Delta% V(mean) and Deltamicromol/L cerebral oxyhemoglobin, deoxyhemoglobin, and total hemoglobin per mm Hg change in end-tidal CO2 tension. Both ways of measurements revealed lower cerebrovascular CO2 responsiveness in SCD patients versus controls (V(mean), 3.7, 3.1-4.7 vs 5.9, 4.6-6.7 Delta% V(mean) per mm Hg, P < .001; oxyhemoglobin, 0.36, 0.14-0.82 vs 0.78, 0.61-1.22 Deltamicromol/L per mm Hg, P = .025; deoxyhemoglobin, 0.35, 0.14-0.67 vs 0.58, 0.41-0.86 Deltamicromol/L per mm Hg, P = .033; total-hemoglobin, 0.13, 0.02-0.18 vs 0.23, 0.13-0.38 Deltamicromol/L per mm Hg, P = .038). Cerebrovascular CO2 responsiveness was not related to markers of hemolytic anemia. In SCD patients, impaired cerebrovascular CO2 responsiveness reflects reduced cerebrovascular reserve capacity, which may play a role in pathophysiology of stroke.
Authors:
Erfan Nur; Yu-Sok Kim; Jasper Truijen; Eduard J van Beers; Shyrin C A T Davis; Dees P Brandjes; Bart J Biemond; Johannes J van Lieshout
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-08-21
Journal Detail:
Title:  Blood     Volume:  114     ISSN:  1528-0020     ISO Abbreviation:  Blood     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2009-11-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7603509     Medline TA:  Blood     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3473-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anemia, Sickle Cell / blood,  complications,  epidemiology,  physiopathology*
Blood Flow Velocity
Brain Ischemia / blood,  epidemiology,  etiology,  physiopathology*
Carbon Dioxide / blood
Cerebrovascular Circulation*
Female
Hemoglobins / analysis
Humans
Incidence
Male
Nitric Oxide / blood
Oxygen / blood
Oxyhemoglobins / analysis
Risk Factors
Stroke / blood,  epidemiology,  etiology,  physiopathology*
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Oxyhemoglobins; 10102-43-9/Nitric Oxide; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen; 9008-02-0/deoxyhemoglobin

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