Reliability of dynamic cerebral autoregulation measurement using spontaneous fluctuations in blood pressure

被引:94
作者
Brodie, Fiona G. [1 ]
Atkins, Emily R. [1 ]
Robinson, Thompson G. [1 ]
Panerai, Ronney B. [2 ]
机构
[1] Univ Leicester, Univ Hosp Leicester NHS Trust, Dept Cardiovasc Sci, Leicester LE5 4PW, Leics, England
[2] Leicester Royal Infirm, Dept Cardiovasc Sci, Med Phys Grp, Leicester LE1 5WW, Leics, England
关键词
blood pressure; cerebral autoregulation; cerebral haemodynamics; reproducibility of results; transcranial Doppler ultrasound; CRITICAL CLOSING PRESSURE; FLOW-VELOCITY; ISCHEMIC-STROKE; HEMODYNAMICS; HYPERTENSION; CIRCULATION; ARTERIES; HUMANS; MILD;
D O I
10.1042/CS20080236
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Spontaneous fluctuations in BP (blood pressure) and subsequent change in CBFV (cerebral blood flow velocity) in the MCA (middle cerebral artery) can be used to assess dynamic cerebral autoregulation using transfer function analysis; however, the reliability of this technique has not been assessed, in particular the contribution of intra-subject variability relative to inter-subject variability. Three bilateral CBFV, BP and RR interval recordings were performed in ten healthy volunteers on four separate occasions over a 2-week period. Data were analysed to provide the ARI (autoregulatory index), CBFV, RAP (resistance-area product) and CrCP (critical closing pressure). We also measured systolic and diastolic BP, and resting HR (heart rate). We calculated the SEM (standard error of measurement) and the ICC (intra-class correlation coefficient) and their 95% CIs (confidence intervals) for each parameter to assess their absolute (intra-subject) and relative (inter-subject) reliability. The CV (coefficient of variation) of SEM ranged from 1.7% (for CBFV) to 100.0 % (for RAP), whereas the ICC was < 0.5 for ARI, rising to > 0.8 for CBFV and diastolic BP. These data demonstrate excellent absolute and relative reliability of CBFV, whereas ARI is of comparable reliability with the measurement of HR. Using these results it is possible to determine the sample size required to demonstrate a change in ARI, with a sample of 45 subjects in each group required to show a change in ARI of 1, whereas to detect a change in ARI > 2 would require only II subjects per group. The results of the present study could be valuable to the future planning of cerebral autoregulation studies, but more work is needed to undersrand the determinants of intra-subject variability in autoregulatory parameters.
引用
收藏
页码:513 / 520
页数:8
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