Relationship between the ambulatory arterial stiffness index and the lower limit of cerebral autoregulation during cardiac surgery

Yurie Obata, Viachaslau Barodka, Dan E Berkowitz, Allan Gottschalk, Charles W. Hogue, Jochen Steppan

Research output: Contribution to journalArticle

Abstract

Background--Pulse pressure, the ambulatory arterial stiffness index (AASI), and the symmetric AASI are established predictors of adverse cardiovascular outcomes. However, little is known about their relationship to cerebral autoregulation. This study evaluated whether these markers of vascular properties relate to the lower limit of cerebral autoregulation (LLA). Methods and Results--The LLA was determined during cardiac surgery with transcranial Doppler ultrasonography in 181 patients. All other variables were calculated from continuous intraoperative readings obtained before cardiopulmonary bypass. The LLA varied directly with the AASI (β=3.12 per 0.1 change in AASI, P < 0.001) and to a lesser extent the symmetric AASI (β=2.02 per 0.1 change in symmetric AASI, P≤0.022), while peripheral pulse pressure was not significantly related (β=0.0, P > 0.99). Logistic regression revealed that the likelihood of LLA being > 65 mm Hg increased by 50% (95% confidence interval, 11%-102%, P=0.008) for every 0.1 increase in the AASI. The AASI was able to predict a LLA above certain thresholds (area under the curve receiver operating characteristic for AASI predicting an LLA > 65 mm Hg: 0.60; 95% confidence interval, 0.51%-0.68%, P = 0.043). Incorporating additional variables improved the model's predictive ability (area under the curve for AASI predicting a LLA > 65 mm Hg: 0.75; 95% confidence interval, 0.68-0.82, P=0.036). Conclusions--These data indicate that the LLA is related to the mechanical properties of the vasculature as represented by the AASI. The AASI can be used to predict LLA threshold levels during cardiac surgery. It is now possible to link elevations in the LLA with an increased AASI as determined from readily accessible intraoperative variables.

Original languageEnglish (US)
Article numbere007816
JournalJournal of the American Heart Association
Volume7
Issue number4
DOIs
StatePublished - Feb 1 2018

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Vascular Stiffness
Thoracic Surgery
Homeostasis
Confidence Intervals
Area Under Curve
Doppler Transcranial Ultrasonography
Cardiopulmonary Bypass
ROC Curve
Blood Vessels
Reading
Logistic Models
Blood Pressure

Keywords

  • Ambulatory arterial stiffness index
  • Cardiac surgery
  • Cerebral autoregulation
  • Lower limit of cerebral autoregulation
  • Pulse pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{621c38995dd04347b42a124f9bfd718f,
title = "Relationship between the ambulatory arterial stiffness index and the lower limit of cerebral autoregulation during cardiac surgery",
abstract = "Background--Pulse pressure, the ambulatory arterial stiffness index (AASI), and the symmetric AASI are established predictors of adverse cardiovascular outcomes. However, little is known about their relationship to cerebral autoregulation. This study evaluated whether these markers of vascular properties relate to the lower limit of cerebral autoregulation (LLA). Methods and Results--The LLA was determined during cardiac surgery with transcranial Doppler ultrasonography in 181 patients. All other variables were calculated from continuous intraoperative readings obtained before cardiopulmonary bypass. The LLA varied directly with the AASI (β=3.12 per 0.1 change in AASI, P < 0.001) and to a lesser extent the symmetric AASI (β=2.02 per 0.1 change in symmetric AASI, P≤0.022), while peripheral pulse pressure was not significantly related (β=0.0, P > 0.99). Logistic regression revealed that the likelihood of LLA being > 65 mm Hg increased by 50{\%} (95{\%} confidence interval, 11{\%}-102{\%}, P=0.008) for every 0.1 increase in the AASI. The AASI was able to predict a LLA above certain thresholds (area under the curve receiver operating characteristic for AASI predicting an LLA > 65 mm Hg: 0.60; 95{\%} confidence interval, 0.51{\%}-0.68{\%}, P = 0.043). Incorporating additional variables improved the model's predictive ability (area under the curve for AASI predicting a LLA > 65 mm Hg: 0.75; 95{\%} confidence interval, 0.68-0.82, P=0.036). Conclusions--These data indicate that the LLA is related to the mechanical properties of the vasculature as represented by the AASI. The AASI can be used to predict LLA threshold levels during cardiac surgery. It is now possible to link elevations in the LLA with an increased AASI as determined from readily accessible intraoperative variables.",
keywords = "Ambulatory arterial stiffness index, Cardiac surgery, Cerebral autoregulation, Lower limit of cerebral autoregulation, Pulse pressure",
author = "Yurie Obata and Viachaslau Barodka and Berkowitz, {Dan E} and Allan Gottschalk and Hogue, {Charles W.} and Jochen Steppan",
year = "2018",
month = "2",
day = "1",
doi = "10.1161/JAHA.117.007816",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Relationship between the ambulatory arterial stiffness index and the lower limit of cerebral autoregulation during cardiac surgery

AU - Obata, Yurie

AU - Barodka, Viachaslau

AU - Berkowitz, Dan E

AU - Gottschalk, Allan

AU - Hogue, Charles W.

AU - Steppan, Jochen

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background--Pulse pressure, the ambulatory arterial stiffness index (AASI), and the symmetric AASI are established predictors of adverse cardiovascular outcomes. However, little is known about their relationship to cerebral autoregulation. This study evaluated whether these markers of vascular properties relate to the lower limit of cerebral autoregulation (LLA). Methods and Results--The LLA was determined during cardiac surgery with transcranial Doppler ultrasonography in 181 patients. All other variables were calculated from continuous intraoperative readings obtained before cardiopulmonary bypass. The LLA varied directly with the AASI (β=3.12 per 0.1 change in AASI, P < 0.001) and to a lesser extent the symmetric AASI (β=2.02 per 0.1 change in symmetric AASI, P≤0.022), while peripheral pulse pressure was not significantly related (β=0.0, P > 0.99). Logistic regression revealed that the likelihood of LLA being > 65 mm Hg increased by 50% (95% confidence interval, 11%-102%, P=0.008) for every 0.1 increase in the AASI. The AASI was able to predict a LLA above certain thresholds (area under the curve receiver operating characteristic for AASI predicting an LLA > 65 mm Hg: 0.60; 95% confidence interval, 0.51%-0.68%, P = 0.043). Incorporating additional variables improved the model's predictive ability (area under the curve for AASI predicting a LLA > 65 mm Hg: 0.75; 95% confidence interval, 0.68-0.82, P=0.036). Conclusions--These data indicate that the LLA is related to the mechanical properties of the vasculature as represented by the AASI. The AASI can be used to predict LLA threshold levels during cardiac surgery. It is now possible to link elevations in the LLA with an increased AASI as determined from readily accessible intraoperative variables.

AB - Background--Pulse pressure, the ambulatory arterial stiffness index (AASI), and the symmetric AASI are established predictors of adverse cardiovascular outcomes. However, little is known about their relationship to cerebral autoregulation. This study evaluated whether these markers of vascular properties relate to the lower limit of cerebral autoregulation (LLA). Methods and Results--The LLA was determined during cardiac surgery with transcranial Doppler ultrasonography in 181 patients. All other variables were calculated from continuous intraoperative readings obtained before cardiopulmonary bypass. The LLA varied directly with the AASI (β=3.12 per 0.1 change in AASI, P < 0.001) and to a lesser extent the symmetric AASI (β=2.02 per 0.1 change in symmetric AASI, P≤0.022), while peripheral pulse pressure was not significantly related (β=0.0, P > 0.99). Logistic regression revealed that the likelihood of LLA being > 65 mm Hg increased by 50% (95% confidence interval, 11%-102%, P=0.008) for every 0.1 increase in the AASI. The AASI was able to predict a LLA above certain thresholds (area under the curve receiver operating characteristic for AASI predicting an LLA > 65 mm Hg: 0.60; 95% confidence interval, 0.51%-0.68%, P = 0.043). Incorporating additional variables improved the model's predictive ability (area under the curve for AASI predicting a LLA > 65 mm Hg: 0.75; 95% confidence interval, 0.68-0.82, P=0.036). Conclusions--These data indicate that the LLA is related to the mechanical properties of the vasculature as represented by the AASI. The AASI can be used to predict LLA threshold levels during cardiac surgery. It is now possible to link elevations in the LLA with an increased AASI as determined from readily accessible intraoperative variables.

KW - Ambulatory arterial stiffness index

KW - Cardiac surgery

KW - Cerebral autoregulation

KW - Lower limit of cerebral autoregulation

KW - Pulse pressure

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