Article Text
Abstract
Objectives: To compare changes in cerebral autoregulation in response to controlled, lower body negative pressure-induced hypotension in patients with carotid sinus syndrome (CSS) and case controls.
Design: Prospective case controlled study.
Setting: Secondary and tertiary referral falls and syncope service.
Patients: 17 consecutive patients with CSS and 11 asymptomatic controls.
Interventions: Hypotension insufficient to cause syncope induced by lower body negative pressure (minimum 30 mm Hg fall in systolic blood pressure (SBP)) during concomitant transcranial Doppler ultrasonography.
Main outcome measures: Cerebral autoregulation (systolic, diastolic and mean middle cerebral arterial blood flow velocities and cerebrovascular resistance) with continuous end-tidal carbon dioxide and haemodynamic monitoring.
Results: Cerebral autoregulatory indices differed significantly between patients with CSS and controls. Systolic, diastolic and middle cerebral arterial blood flow velocities were, respectively, 9.2 m/s (95% confidence interval (CI) 2.9 to 15.4 m/s), 4.7 m/s (95% CI 1.5 to 7.9 m/s) and 6.9 m/s (95% CI 2.5 to 11.4 m/s) slower in patients with CSS. Cerebrovascular resistance was significantly greater in patients with CSS than in controls at SBP nadir and suction release; differences were 0.9 mm Hg/m/s (95% CI 0.0 to 1.7 mm Hg/m/s) and 0.8 mm Hg/m/s (95% CI 0.0 to 1.7 mm Hg/m/s), respectively. End-tidal carbon dioxide and systemic haemodynamic variables were similar for patients and controls at baseline and during lower body negative pressure.
Conclusions: Cerebral autoregulation is altered in patients with CSS. This difference may have aetiological implications in the differential presentation with falls and drop attacks rather than syncope.
- CSS, carotid sinus syndrome
- CVR, cerebrovascular resistance
- DBFV, diastolic blood flow velocity
- Etco2, end-tidal carbon dioxide concentration
- LBNP, lower body negative pressure
- MAP, mean arterial blood pressure
- MBFV, mean cerebral blood flow velocity
- SBFV, systolic blood flow velocity
- SBP, systolic blood pressure
- TCD, transcranial Doppler ultrasonography
- ageing
- carotid arteries
- cerebral autoregulation
- cerebrovascular circulation
- syncope
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- CSS, carotid sinus syndrome
- CVR, cerebrovascular resistance
- DBFV, diastolic blood flow velocity
- Etco2, end-tidal carbon dioxide concentration
- LBNP, lower body negative pressure
- MAP, mean arterial blood pressure
- MBFV, mean cerebral blood flow velocity
- SBFV, systolic blood flow velocity
- SBP, systolic blood pressure
- TCD, transcranial Doppler ultrasonography
Footnotes
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Published Online First 31 January 2006
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Sources of funding: Dr Parry was supported by the British Heart Foundation.
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Conflicts of interest: None declared.