Malterer, Katherine R.

Background Evidence indicates that the carotid chemoreceptors play a minimal role in regulating cerebral blood flow under normoxic resting conditions. However, studies in heart failure suggest over‐active carotid chemoreceptors may decrease cerebral blood flow. With this information in mind, we hypothesized that individuals with the highest resting chemosensitivity will have the greatest increase in cerebral blood flow when the carotid chemoreceptors are desensitized with low‐dose IV dopamine. Methods Seven young, healthy men (33±3 y) participated in two randomized, double‐blinded study days separated by at least 4 weeks. Middle cerebral artery blood velocity (MCAv, transcranial Doppler) was measured continuously as a surrogate for cerebral blood flow. Cerebral vascular conductance index (CVCi) was calculated by normalizing MCAv for blood pressure as measured by brachial arterial catheter (MCAv/mean arterial blood pressure) and blood gasses were drawn. Subjects rested quietly in the supine position for 5‐minutes during intravenous saline infusion (saline and dopamine baseline). This was followed by a 25‐minute continuous IV infusion of either saline or dopamine. The dose of dopamine was individualized (1–2 μg/kg/min) such that it resulted in a nadir hypoxic ventilatory response. Data were analyzed from the last 5‐minutes of the infusion period (saline infusion or dopamine infusion) and compared to baseline data. Results Saline and dopamine infusion did not affect mean arterial blood pressure (% change saline vs dopamine day: 1.3±1.2 vs 0.9±1.3%; p>0.05) or arterial blood CO 2 (% change saline vs dopamine day: −2.6±1.7 vs 1.6±1.9%; p>0.05). Dopamine infusion resulted in a significant reduction in carotid body chemosensitivity as assessed by the hypoxic ventilatory response (dopamine baseline vs infusion HVR: 0.33±0.06 vs 0.17±0.03 L/min/%SpO 2 ; p=0.027). No changes in MCAv or CVCi were observed with saline infusion (saline baseline vs infusion: p>0.05). Dopamine did not alter MCAv (dopamine baseline vs infusion: 62±5 vs 64±5 cm/s; p>0.05). Similarly, no changes in CVCi were observed with dopamine infusion (dopamine baseline vs infusion: 0.68±0.07 vs 0.68±0.06 cm/s/mmHg; p>0.05). Although differences in group means for MCAv and CVCi were not observed with dopamine infusion, a significant negative relationship was found between baseline carotid chemosensitivity and the change in MCAv (r 2 =0.594, p=0.043), and CVCi (r 2 =0.741, p=0.013). With saline infusion, no significant relationship was found between baseline carotid chemosensitivity and the change in MCAv (r 2 =0.091, p>0.05), and CVCi (r 2 =0.089, p>0.05). Conclusions Blunting of the carotid chemoreceptors using IV dopamine has no group effect on MCAv or CVCi. However, contrary to our hypothesis, individuals with highest resting chemosensitivity had either a decrease or no change in cerebral blood flow after carotid body desensitization. Support or Funding Information W81XWH‐13‐2‐003

Cerebral blood flow velocity responses to hypercapnia are blunted by the cyclooxygenase inhibitor indomethacin (INDO). We hypothesized that INDO would also attenuate middle cerebral artery blood flow velocity (MCAv) responses to an acute cognitive challenge. We evaluated the MCAv responses to an acute cognitive challenge in 20 healthy young (20‐35 yrs) and older (56‐76 yrs) healthy adults, including 10 men and 10 women before and 90 minutes after INDO administration. The cognitive challenge consisted of 2 blocks of the Stroop color word test: easy (3 colors) and difficult (8 colors). Mean arterial pressure (MAP), end‐tidal CO 2 , and MCAv were monitored throughout the protocol. There were no differences in MAP or end tidal CO 2 between trials. Indeed, MCAv was lower during INDO than baseline for both the easy (50±4 vs. 68±4 cm/s; p<0.01) and difficult (49±3 vs. 66±3 cm/s; p<0.001) cognitive challenges. Additionally, there was an Age x Sex interaction for the increase in MCAv during the easy cognitive task, with older men having a greater increase than older women (15±5 vs. ‐1±5%, respectively; p<0.05). This interaction was not statistically significant for the difficult cognitive task or during the INDO trial. In conclusion, similar to hypercapnia, the cyclooxygenase inhibitor INDO blunts cerebral blood flow velocity responses to an acute cognitive challenge. Funded by NIH grant HL 118154

Cerebrovascular reactivity (CVR) is reduced in patients with cognitive decline. Women with a history of preeclampsia are at increased risk for cognitive decline. This study examined an association between pregnancy history and CVR using a subgroup of 40 age- and parity-matched pairs of women having histories of preeclampsia (n=27) or normotensive pregnancy (n=29) and the association of activated blood elements with CVR. Middle cerebral artery velocity was measured by Doppler ultrasound before and during hypercapnia to assess CVR. Thirty-eight parameters of blood cellular elements, microvesicles, and cell–cell interactions measured in venous blood were assessed for association with CVR using principal component analysis. Middle cerebral artery velocity was lower in the preeclampsia compared with the normotensive group at baseline (63±4 versus 73±3 cm/s; P =0.047) and during hypercapnia ( P =0.013–0.056). CVR was significantly lower in the preeclampsia compared with the normotensive group (2.1±1.3 versus 2.9±1.1 cm·s·mm Hg; P =0.009). Globally, the association of the 7 identified principal components with preeclampsia ( P =0.107) and with baseline middle cerebral artery velocity ( P =0.067) did not reach statistical significance. The interaction between pregnancy history and principal components with respect to CVR ( P =0.084) was driven by a nominally significant interaction between preeclampsia and the individual principal component defined by blood elements, platelet aggregation, and interactions of platelets with monocytes and granulocytes ( P =0.008). These results suggest that having a history of preeclampsia negatively affects the cerebral circulation years beyond the pregnancy and that this effect was associated with activated blood elements.