Cerebral autoregulation assessed by near-infrared spectroscopy: validation using transcranial Doppler in patients with controlled hypertension, cognitive impairment and controls

Arjen Mol, Carel G M Meskers, Marit L Sanders, Martin Müller, Andrea B Maier, Richard J A van Wezel, Jurgen A H R Claassen, Jan Willem J Elting, Arjen Mol, Carel G M Meskers, Marit L Sanders, Martin Müller, Andrea B Maier, Richard J A van Wezel, Jurgen A H R Claassen, Jan Willem J Elting

Abstract

Purpose: Cerebral autoregulation (CA) aims to attenuate the effects of blood pressure variation on cerebral blood flow. This study assessed the criterion validity of CA derived from near-infrared spectroscopy (NIRS) as an alternative for Transcranial Doppler (TCD).

Methods: Measurements of continuous blood pressure (BP), oxygenated hemoglobin (O2Hb) using NIRS and cerebral blood flow velocity (CBFV) using TCD (gold standard) were performed in 82 controls, 27 patients with hypertension and 94 cognitively impaired patients during supine rest (all individuals) and repeated sit to stand transitions (cognitively impaired patients). The BP-CBFV and BP-O2Hb transfer function phase shifts (TFφ) were computed as CA measures. Spearman correlations (ρ) and Bland Altman limits of agreement (BAloa) between NIRS- and TCD-derived CA measures were computed. BAloa separation < 50° was considered a high absolute agreement.

Results: NIRS- and TCD-derived CA estimates were significantly correlated during supine rest (ρ = 0.22-0.30, N = 111-120) and repeated sit-to-stand transitions (ρ = 0.46-0.61, N = 19-32). BAloa separation ranged between 87° and 112° (supine rest) and 65°-77° (repeated sit to stand transitions).

Conclusion: Criterion validity of NIRS-derived CA measures allows for comparison between groups but was insufficient for clinical application in individuals.

Keywords: Cerebral autoregulation; Cognitive dysfunction; Hypertension; Near-infrared spectroscopy; Transcranial Doppler.

Conflict of interest statement

All author(s) declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Grand average of BP-CBFV and BP-O2Hb TFφ in supine rest and during repeated sit to stand transitions, per cohort. The blue and red traces are the BP-O2Hb TFφs before and after correction, respectively. The yellow dotted lines are the means lines of the BP-O2Hb TFφ in the high frequency (HF) range. MCI mild cognitive impairment, AD Alzheimer’s dementia
Fig. 2
Fig. 2
Bland Altman plots showing agreement between NIRS- and TCD- derived CA measures during supine rest and repeated sit-to-stand transitions. The horizontal solid lines indicate the mean difference; the horizontal dashed lines indicate the 95% limits of agreement. VLF very low-frequency range, LF low-frequency range

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