Cerebrovascular response to normal pregnancy: a longitudinal study

We used a longitudinal study design (gestational weeks 8, 15, 22, 29, and 36 and 12 wk postpartum ) to investigate the effect of normal pregnancy on cerebral autoregulation and pressor response. Blood flow velocities in the right internal carotid artery, end-tidal CO2, and mean arterial pressure (MAP) were simultaneously and continuously recorded in 16 healthy pregnant women during standardized hyperventilation and handgrip. Blood flow velocities were recorded using Doppler ultrasound sampled beat by beat using the ECG signal. The results demonstrate that the vasoconstrictor response to hyperventilation is unchanged during pregnancy. During standardized handgrip, MAP showed a statistically significant increase during pregnancy that did not affect cerebral blood flow. A statistically significant reduction in the MAP response to handgrip was seen in week 36. In conclusion, pregnancy has no impact on cerebral autoregulation. There is an impact on the pressor response resulting in a blunted reaction at week 36, probably caused by a fall in the baroreflex set point.     

Abnormal arterial flows by a distributed model of the fetal circulation

Modeling the propagation of blood pressure and flow along the fetoplacental arterial tree may improve interpretation of abnormal flow velocity waveforms in fetuses. The current models, however, either do not include a wide range of gestational ages or do not account for variation in anatomical, vascular, or rheological parameters. We developed a mathematical model of the pulsating fetoumbilical arterial circulation using Womersley's oscillatory flow theory and viscoelastic arterial wall properties. Arterial flow waves are calculated at different arterial locations from which the pulsatility index (PI) can be determined. We varied blood viscosity, placental and brain resistances, placental compliance, heart rate, stiffness of the arterial wall, and length of the umbilical arteries. The PI increases in the umbilical artery and decreases in the cerebral arteries, as a result of increasing placental resistance or decreasing brain resistance. Both changes in resistance decrease the flow through the placenta. An increased arterial stiffness increases the PIs in the entire fetoplacental circulation. Blood viscosity and peripheral bed compliance have limited influence on the flow profiles. Bradycardia and tachycardia increase and decrease the PI in all arteries, respectively. Umbilical arterial length has limited influence on the PI but affects the mean arterial pressure at the placental cord insertion. The model may improve the interpretation of arterial flow pulsations and thus may advance both the understanding of pathophysiological processes and clinical management.     

Vascular reactivity to carbon dioxide in the acute stage of cerebral infarction in rats

The effect of CO2 on the cerebral circulation was assessed 24 hours after induction of unilateral brain infarction performed in the rat by injecting radioactive calibrated 50 microns microspheres into the internal carotid artery. The intracerebral distribution of microspheres and regional cerebral blood flow were measured bilaterally in 8 brain regions. In control rats, increase in arterial pCO2 to about 80 mm Hg resulted in 30 to 100% increase in flow according to the area. Cerebral blood flow was also enhanced in the embolized rats, the basal values being multiplied by a factor 1.7 in the embolized hemisphere and by a factor 1.8 in the contralateral hemisphere. These results do not provide evidence for the existence of a "steal" phenomenon between the non infarcted and infarcted hemispheres.     

Autoregulation of renal hemodynamics is not impaired by a 'physiologic' dose of glucagon

Glucagon has been suggested to be involved in the pathway by which protein and amino acids elevate renal blood flow (RBF) and glomerular filtration rate (GFR) postprandially. Recent data suggest that amino acids elevate RBF and GFR through an autoregulatory mechanism (i.e., by impairing renal autoregulation). If glucagon mediates the renal hemodynamic effects of amino acids, 'physiologic' infusion of glucagon would also be expected to impair autoregulation. We examined the effects of glucagon (5 ng/kg per min given intraportally and intravenously) on RBF and GFR autoregulation in anesthetized dogs. Intraportal glucagon (n = 6) increased RBF (24%) and GFR (23%) at normal arterial pressure. RBF and GFR were well autoregulated (greater than 90% of control) at renal arterial pressures greater than or equal to 85 mm Hg before and after glucagon. At 70 mm Hg, RBF and GFR decreased by 15 and 16%, respectively, before glucagon and by 19 and 22%, respectively, after glucagon. Intravenous glucagon (n = 6) produced similar effects. Intraportal glucagon at 500 ng/kg per min increased RBF (35%), heart rate (69%) and plasma glucose (78%) and decreased arterial pressure (16%) (GFR not measured). This dose impaired RBF autoregulation by 30%. The data suggest that a 'physiologic' dose of glucagon increases renal hemodynamics without impairing renal autoregulation. It is suggested that glucagon's vasodilatory effect on the renal vasculature may be additive to the renal effects of amino acids.     

Effect of Yoshida ascites tumour on the circulation in rats

The circulation in anaesthetized rats with Yoshida ascites tumour was studied. Cardiac output was determined according to the reference flow method, while the distribution of cardiac output by labelled microspheres 15 mu in diameter. Arterial blood pressure decreased by 39 mm Hg and TPR by 23% at unaltered cardiac output. Blood flow of the brain and the coronaries increased by 39-43% while that of the kidney and the intestines decreased by 43 and 28%, respectively. The cardiac output fractions of the brain, the coronaries and the hepatic artery increased considerably, while that of the kidney decreased. The haematocrit decreased from 43 to 23%. It is assumed that part of the circulatory alterations (redistribution of cardiac output) were due to the anaemia and its consequences, while the others (arterial hypotension, lack of increase in cardiac output) should be regarded as an effect of a factor reaching the circulation from the cells of the ascites tumour.     

A global mathematical model of the cerebral circulation in man

A mathematical model of the cerebral circulation has been formulated. It was based on non-linear equations of pulsatile fluid flow in distensible conduits and applied to a network simulating the entire cerebral vasculature, from the carotid and vertebral arteries to the sinuses and the jugular veins. The quasilinear hyperbolic system of equations was numerically solved using the two-step Lax-Wendroff scheme. The model's results were in good agreement with pressure and flow data recorded in humans during rest. The model was also applied to the study of autoregulation during arterial hypotension. A close relationship between cerebral blood flow (CBF) and capillary pressure was obtained. At arterial pressure of 80 mmHg, the vasodilation of the pial arteries was unable to maintain CBF at its control value. At the lower limit of autoregulation (60 mm Hg), CBF was maintained with a 25% increase of zero transmural pressure diameter of nearly the whole arterial network.     

Cerebrovascular autoregulation is profoundly impaired in mice overexpressing amyloid precursor protein

The amyloid-beta (A beta) peptide, which is derived from the amyloid precursor protein (APP), is involved in the pathogenesis of Alzheimer's dementia and impairs endothelium-dependent vasodilation in cerebral vessels. We investigated whether cerebrovascular autoregulation, i.e., the ability of the cerebral circulation to maintain flow in the face of changes in mean arterial pressure (MAP), is impaired in transgenic mice that overexpress APP and A beta. Neocortical cerebral blood flow (CBF) was monitored by laser-Doppler flowmetry in anesthetized APP(+) and APP(-) mice. MAP was elevated by intravenous infusion of phenylephrine and reduced by controlled exsanguination. In APP(-) mice, autoregulation was preserved. However, in APP(+) mice, autoregulation was markedly disrupted. The magnitude of the disruption was linearly related to brain A beta concentration. The failure of autoregulation was paralleled by impairment of the CBF response to endothelium-dependent vasodilators. Thus A beta disrupts a critical homeostatic mechanism of the cerebral circulation and renders CBF highly dependent on MAP. The resulting alterations in cerebral perfusion may play a role in the brain dysfunction and periventricular white-matter changes associated with Alzheimer's dementia.     

Systemic hemodynamics affecting cardiac output during hypocapnic and hypercapnic hypoxia

Systemic hemodynamic adjustments involved in the control of cardiac output (CO) were examined in chronically instrumented unanesthetized sheep inhaling gas mixtures resulting in hypocapnic hypoxia (H) [arterial pH (pHa) = 7.53, arterial partial pressure of O2 (Pao2) = 30 Torr, arterial partial pressure of CO2 (Paco2) = 29 Torr] or hypercapnic hypoxia (HCH) (pHa = 7.14, Pao2 = 34 Torr, Paco2 = 72 Torr) for 1 h. H (n = 7) and HCH (n = 6) resulted in 26% and 61% increases in CO, respectively, and mean systemic arterial pressure rose to a greater extent during HCH. Both H and HCH resulted in increased blood flow (microsphere method) to the peripheral systemic circulation including the brain, heart, diaphragm, and nonrespiratory skeletal muscle (the latter blood flow increased 120% during H and 380% during HCH). Gastrointestinal and renal blood flow remained unchanged during H and HCH. Transit time of green dye from the pulmonary artery to regional veins in the hindlimb and intestine was 5.0 and 8.2 s, respectively, during base-line conditions and remained unchanged with HCH. During HCH, regional O2 consumption increased 274% for the hindlimb and decreased 39% for the intestine. Total catecholamines rose 250% during H and 3,700% during HCH. During hypocapnic and hypercapnic hypoxia, CO is augmented in part by systemic hemodynamic adjustments that include a redistribution of blood flow and a translocation of blood volume to the fast transit time peripheral systemic circuit. The sympathetic nervous system may play an important role in mediating these systemic hemodynamic adjustments.     

Interaction between nitric oxide and renal myogenic autoregulation in normotensive and hypertensive rats

Blood pressure fluctuates continuously throughout life and autoregulation is the primary mechanism that isolates the kidney from this fluctuation. Compared with Wistar rats, Brown Norway (B-N) rats display impaired renal myogenic autoregulation when blood pressure fluctuation is increased. They also are very susceptible to hypertension-induced renal injury. Because blockade of nitric oxide augments myogenic autoregulation in Wistar rats, we compared the response of the myogenic system in B-N rats to nitric oxide blockade with that of other strains [Wistar, Sprague-Dawley, Long-Evans, spontaneously hypertensive (SHR)]. Renal blood flow dynamics were assessed in isoflurane anesthetized rats before and after inhibition of nitric oxide synthase by Lomega-nitro-arginine methyl-ester (L-NAME, 10 mg/kg, iv). Under control conditions, myogenic autoregulation in the B-N rats was weaker than in the other strains. Myogenic autoregulation was not augmented after L-NAME administration in the SHR, but was augmented in all the normotensive rats. The enhancement was significantly greater in B-N rats so that after L-NAME the efficiency of autoregulation did not differ among the strains. The data suggest that nitric oxide is involved in the impaired myogenic autoregulation seen in B-N rats. Furthermore, the similarity of response in Wistar, Long-Evans, and Sprague-Dawley rats suggests that modulation by nitric oxide is a fundamental property of renal myogenic autoregulation.     

Cerebral blood flow in intoxicated newborn piglets

Ethanol exposure in the neonatal period causes impaired brain growth and altered adult behaviour in rats. One possible mechanism may be altered cerebral perfusion caused by ethanol intoxication. We assessed the effects of ethanol on cerebral blood flow and its autoregulation in 2-day-old piglets. Piglets received ethanol (1.4 g/kg) or an equivalent volume of dextrose 5% in water over 30 min. One hour later, cerebral blood flow was measured using the microsphere technique at resting, elevated, and decreased mean arterial blood pressure. Ethanol-treated piglets had total cerebral blood flows of 88 +/- 14, 82 +/- 10, and 82 +/- 12 mL X 100 g-1 X min-1 (mean +/- SE) at mean arterial blood pressures of 12.4 +/- 1.1, 15.7 +/- 1.5, and 8.2 +/- 0.9 kPa. Corresponding values in control piglets were 82 +/- 14, 78 +/- 4, and 82 +/- 7 mL X 100 g-1 X min-1 at mean arterial blood pressures of 10.5 +/- 1.5, 14.0 +/- 1.2, and 7.7 +/- 1.1 kPa. At resting arterial blood pressures, regional blood flows to basal ganglia, cortex, brainstem, and cerebellum in ethanol-treated piglets were 123 +/- 21, 90 +/- 16, 94 +/- 17, and 77 +/- 12 mL X 100 g-1 X min-1, respectively. Corresponding regional blood flows for the control piglets were 118 +/- 16, 85 +/- 15, 76 +/- 16, and 76 +/- 16 mL X 100 g-1 X min-1. Blood flow to basal ganglia was greater than to other brain regions in both ethanol-treated and control piglets (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Pressure-flow relations of diaphragm and vital organs with nitroprusside-induced vasodilatation

We determined maximal conductance in the diaphragm and other vital organs in 14 anesthetized dogs, weighing 22.8 +/- 4.2 kg, which were given maximal vasodilating doses of nitroprusside (mean dose 13.9 +/- 4.3 micrograms X kg-1 X min-1) and the blood pressure was lowered in stages by hemorrhage. Blood flow in the diaphragm, brain, heart, kidney, gut, and quadriceps was measured with radiolabeled microspheres. To ensure maximal vasodilatation of diaphragmatic vessels, we stimulated the phrenic nerves to produce diaphragmatic contractions at 0.3 Hz. The mean cardiac output was 2.13 +/- 0.42 l/min (thermodilution) before nitroprusside and 4.68 +/- 1.45 after (P less than 0.001). Nitroprusside failed to break the autoregulation of the brain. Pressure-flow relations (P-F) in other regions were linear (r = 0.70 +/- 0.03, P less than 0.001) and blood pressure at zero flow (X-intercept) was always greater than venous pressure (diaphragm = 11, kidney = 19, heart = 8, gut = 8, quadriceps = 32 mmHg). The flow to the diaphragm (Qdi) could be predicted by Qdi (ml X min-1 X g-1) = [(3.13 +/- 0.56) X Pa X 10(-2)] -0.52 (r = 0.71), where Pa is mean arterial pressure. The maximal vascular conductance (i.e., slope of the P-F relation) of the diaphragm was 27% of the conductance in the kidney, 87% of the value in the gut, and 42% of that in the heart. In conclusion the maximal diaphragmatic blood flow at a given blood pressure is much larger when the muscle is stimulated than is observed in spontaneously breathing animals.     

Failure of cerebral autoregulation as a cause of brain dysfunction in the elderly.

Cerebral blood flow in relation to change in arterial pressure was measured in 11 elderly patients with postural hypotension. Seven patients with symptoms showed bilateral or unilateral failure of cerebral autoregulation, while the four asymptomatic patients did not. Variations in cerebral autoregulation would explain why some elderly people with minor falls of systemic arterial pressure develop clinical signs of cerebral ischaemia whereas others with greater falls in blood pressure remain asymptomatic. Elderly patients with impaired autoregulation may be at risk of brain damage from minor falls in blood pressure.     

A Computational Model of the Fetal Circulation to Quantify Blood Redistribution in Intrauterine Growth Restriction

Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood flow redistribution in order to maintain delivery of oxygenated blood to the brain. Given that, in the fetus the aortic isthmus (AoI) is a key arterial connection between the cerebral and placental circulations, quantifying AoI blood flow has been proposed to assess this brain sparing effect in clinical practice. While numerous clinical studies have studied this parameter, fundamental understanding of its determinant factors and its quantitative relation with other aspects of haemodynamic remodeling has been limited. Computational models of the cardiovascular circulation have been proposed for exactly this purpose since they allow both for studying the contributions from isolated parameters as well as estimating properties that cannot be directly assessed from clinical measurements. Therefore, a computational model of the fetal circulation was developed, including the key elements related to fetal blood redistribution and using measured cardiac outflow profiles to allow personalization. The model was first calibrated using patient-specific Doppler data from a healthy fetus. Next, in order to understand the contributions of the main parameters determining blood redistribution, AoI and middle cerebral artery (MCA) flow changes were studied by variation of cerebral and peripheral-placental resistances. Finally, to study how this affects an individual fetus, the model was fitted to three IUGR cases with different degrees of severity. In conclusion, the proposed computational model provides a good approximation to assess blood flow changes in the fetal circulation. The results support that while MCA flow is mainly determined by a fall in brain resistance, the AoI is influenced by a balance between increased peripheral-placental and decreased cerebral resistances. Personalizing the model allows for quantifying the balance between cerebral and peripheral-placental remodeling, thus providing potentially novel information to aid clinical follow up.     

Effect of hypercapnia on cerebral blood flow and blood volume in pigs studied by positron emission tomography

Pigs are increasingly used as in vivo models in neuroscience, including studies using positron emission tomography. During anesthesia, cerebral blood flow (CBF) and cerebral blood volume (CBV) are mainly regulated by the partial pressure of CO2 (pCO2) in arterial blood. We sought to determine the effects of increased arterial pCO2 (hypercapnia) on CBF and CBV in anesthetized domestic pigs. We anesthetized 4 pigs and manipulated the tidal volume of the ventilator to different pCO2 levels. Baseline pCO2 was on average 6.5 kPa (n = 9 periods) and hypercapnia pCO2 ranged from 11 to 20 kPa, mean 18.5 kPa (n = 9 periods). Series of dynamic PET scans with H(2)15O (CBF measurements) and C15O (CBV measurements) were performed. CBF increased on average 54%, from mean 0.48 ml blood/min/ml brain tissue during normoxia to 0.74 ml blood/min/ml brain tissue during hypercapnia. CBV increased 41% from mean 0.061 ml blood/ml brain tissue (n = 6) during normoxia to 0.086 ml blood/ml brain tissue (n = 6) during hypercapnia. Our observations indicate that pCO2 levels have a major influence on porcine CBF and CBV and should be controlled in studies where a constant level is crucial.     

Effects of endogenous angiotensin II on the fetal circulation

The role of endogenous angiotensin II in the regulation of the circulation was investigated by infusion of [sar1],[ala8]-angiotensin II, a competitive antagonist of angiotensin II, into fetal sheep with chronically-maintained intravascular catheters. The thesis considered was that angiotensin II may have a greater role in the fetus than in the adult since the autonomic nervous system does not develop fully until late in gestation. Fetal cardiac output and its distribution to various organs and actual blood flows to fetal tissues were determined by the radionuclide-labelled microsphere technique. Intravenous infusion of [sar1], [ala8]-angiotensin II at a rate of 13.95-42.15 microgram/min per kg fetal body weight increased plasma renin activity from a control value of 8.9 +/- 1.6 to 18.9 +/- 3.9 ng/ml per h (SEM). Mean arterial blood pressure fell significantly from a control level of 47 +/- 1.6 to 41 +/- 1.1 mmHg. Blood flow to the unbilical-placental circulation decreased from 239 +/- 27.0 to 198 +/- 20.2 ml/min per kg, but the calculated vascular resistance in the umbilical-placental circulation did not change. Although cardiac output did not change, blood flow to the peripheral circulation, which includes the fetal skin, muscle and and bone and constitutes 75 +/- 0.9% of the total fetal body weight, increased as did flow to the thyroid and adrenal circulations. Endogenous angiotensin II appears to be important in maintaining blood flow to the umbilical-placental circulation by maintaining fetal arterial blood pressure. Angiotensin II exerts this effect by mediating a tonic vasoconstriction primarily in the peripheral circulation.     

The effect of PGH2 on blood flow in the canine renal and superior mesenteric vascular beds

Effects of the prostaglandin endoperoxide, PGH₂, were investigated in the renal and superior mesenteric vascular beds in anesthetized dogs. Vascular effects of a stable PGH₂ analog were also studied in the intestine. Blood flow was measured with electromagnetic flowmeters and vasoactive hormones were administered by close intra-arterial injection. Authentic PGH₂ increased blood flow in the kidney and intestine in a dose-related manner. Mesenteric blood flow was reduced by the PGH₂ analog in a dose-dependent fashion which was similar to the vasoconstrictor activity of norepinephrine in this organ. PGH₂ is biologically unstable and the type and activity of its metabolic products may vary in different regional vascular beds. Most of the known products of PGH₂ metabolism in the kidney are vasodilators whereas in the intestine both vasodilator and vasoconstrictor metabolites are formed. It has been suggested that the vascular activity of PGH₂ in an organ is dependent on the predominant type and activity of specific terminal enzymes that convert PGH₂ to its various vaso-active products.