Abstract TMP57: Cerebral Oxygen Metabolism as a Biomarker to Stratify Stroke Risk in Young Adults with Sickle Cell Disease

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Kristin P Guilliams ◽  
Melanie E Fields ◽  
Dustin K Ragan ◽  
Cihat Eldeniz ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Stroke Risk ◽  
Cerebral Metabolism ◽  
Infarct Volume ◽  
Oxygen Metabolism ◽  
Imaging Biomarkers ◽  
Cerebral Oxygen ◽  
Cerebral Oxygen Metabolism ◽  
Imminent Risk ◽  
Hemispheric Infarct

Background: While imaging biomarkers guide stroke prevention strategies in children with sickle cell (SC) disease, none have been adequately studied in adults. High oxygen extraction (OEF) predicts stroke in non-SC adults with carotid occlusion, while low oxygen metabolism (CMRO 2 ) predicts tissue at imminent risk in acute ischemic stroke. We hypothesized that metrics of cerebral metabolism: (1) differ between SC adults with and without stroke and (2) correlate with infarct burden. Methods: A prospective MRI study enrolled 37 adults (28 ± 8 yr) from SC clinic into 4 groups: (1) 9 age/race matched healthy controls, (2) 6 SC adults without infarcts, (3) 15 SC adults with infarcts (infarct volume 7.4 ± 17.5 ml), and (4) 7 SC adults on chronic transfusions (Tx) (infarct volume 3.6 ± 6.6 ml). Arterial spin labelling and asymmetric spin echo measured voxel-wise cerebral blood flow (CBF) and OEF. CMRO 2 = CBF x OEF x blood oxygen content. Infarcts were delineated on FLAIR. OEF, CBF, and CMRO 2 (excluding infarcted tissue) were compared: between groups 1-3 (Kruskal-Wallis) and in group 4 between pre- and post-tx scans (Signed Rank). An ROI defined by high OEF within the deep white matter (a region at high stroke risk in SC) was applied to group 3. OEF, CBF, and CMRO 2 within the ROI were correlated with hemispheric infarct volume (IV) (Spearman’s ρ ). Results: Whole brain OEF showed a stepwise increase from controls, to SC adults without stroke, to SC adults with stroke (P<.001). SC adults on chronic Tx had intermediate OEF, with lowering of OEF post-Tx (Fig A). CBF and CMRO 2 were similar for SC adults with and without stroke (Fig B, C). High OEF and low CBF/CMRO 2 in the ROI correlated with hemispheric infarct burden: IV vs. OEF ( ρ =.40, P=.043); IV vs. CBF ( ρ =-.61, P=.002); and IV vs. CMRO 2 ( ρ =-.50, P=.016). Conclusion: Global OEF holds promise to stratify stroke risk in SC disease. Regional metrics of cerebral oxygen metabolism may indicate tissue-specific metabolic stress at imminent risk of infarction.

scholarly journals PF742 CEREBRAL OXYGEN METABOLISM MEASUREMENTS WITH MRI IN ADULTS WITH SICKLE CELL DISEASE

HemaSphere ◽  
2019 ◽  
Vol 3 (S1) ◽  
pp. 324-325
Author(s):  
L. Vaclavu ◽  
E. Petersen ◽  
H. Mutsaerts ◽  
J. Petr ◽  
C. Majoie ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Cell Disease ◽  
Cerebral Oxygen Metabolism

scholarly journals Cerebral oxygen metabolism in adults with sickle cell disease

2020 ◽  
Author(s):  
Lena Václavů ◽  
Jan Petr ◽  
Esben Thade Petersen ◽  
Henri J.M.M. Mutsaerts ◽  
Charles B.L. Majoie ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Cell Disease ◽  
Cerebral Oxygen Metabolism

scholarly journals Global and regional techniques for monitoring cerebral oxidative metabolism after severe traumatic brain injury

2000 ◽  
Vol 9 (5) ◽  
pp. 1-3 ◽  
Author(s):  
Alex B. Valadka ◽  
Yu Furuya ◽  
Roman Hlatky ◽  
Claudia S. Robertson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Oxidative Metabolism ◽  
Cerebral Metabolism ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Cerebral Oxygen Metabolism ◽  
Intermittent Sampling ◽  
Cerebral Oxidative Metabolism

The disturbance of normal mechanisms of oxygen delivery and metabolism is a hallmark of severe traumatic brain injury (TBI). In the past, investigations into the status of cerebral oxygen metabolism depended on changes in the differences in oxygen content between arterial and jugular venous blood. The development of jugular venous oximetry permitted continuous monitoring of jugular venous oxygen saturation, thereby overcoming earlier limitations caused by intermittent sampling. Neuromonitoring techniques that utilize only jugular vein sampling provide information only about global cerebral metabolism, but direct measurement of brain tissue oxygen tension via intraparenchymal probes makes possible the assessment of regional cerebral oxygen metabolism. Regional and global neuromonitoring techniques are not competitive or mutually exclusive. Rather, they are best regarded as complementary, with each providing valuable information that has a direct bearing on patient outcomes. The authors review the currently available techniques used in the monitoring of cerebral oxidative metabolism in patients who have sustained severe TBI.

Abstract T P370: Blood Transfusions in Pediatric Sickle Cell Disease Normalize Cerebral Blood Flow While Maintaining Constant Cerebral Oxygen Metabolism

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Hongyu An ◽  
Kristin Guilliams ◽  
Melanie Fields ◽  
Cihat Eldeniz ◽  
...  
Keyword(s):  
Blood Flow ◽  
Oxygen Delivery ◽  
Stroke Risk ◽  
Oxygen Metabolism ◽  
Blood Transfusions ◽  
Compensatory Mechanism ◽  
Cerebral Oxygen ◽  
Cell Disease ◽  
Cerebral Oxygen Metabolism ◽  
Pediatric Sickle Cell Disease

Background: Chronic blood transfusions (Tx) reduces stroke risk in pediatric sickle cell disease (SCD). Cerebral blood flow (CBF) is elevated in SCD, likely representing a compensatory mechanism to maintain cerebral oxygen metabolism (CMRO2) in the setting of reduced arterial oxygen content (CaO2) from chronic anemia. When exhausted compensatory mechanisms are unable to meet oxygen demands, stroke ensues. We measured MR-derived CBF and oxygen extraction fraction (OEF) pre- and post-Tx, hypothesizing that Tx ‘resets’ the CBF baseline by increasing CaO2 via increased hemoglobin (Hb), while maintaining cerebral oxygen delivery and metabolism. Methods: SCD children on chronic Tx were enrolled in a prospective, observational MRI study. MR-CBF and MR-OEF were acquired before and 2 hours after exchange Tx. MR-CBF and MR-OEF were measured using pseudocontinuous arterial spin labelling and a novel asymmetric spin echo sequence, respectively. CaO2 =1.35 x [Hb] x SaO2. CMRO2 = CaO2 x CBF x OEF. Results: Two SCD children underwent MRI pre- and post-Tx (six more are anticipated prior to ISC). For subject #1 (18 yo F with overt stroke), mean global CBF was 128 and 98 ml/min/100g pre- and post-Tx, respectively, indicating a 24% CBF reduction. For subject #2 (6 yo F with elevated transcranial Doppler velocities), mean global CBF was 189 and 129 ml/min/100g pre- and post-Tx, respectively, a 32% CBF reduction (Fig). Both Hb and CaO2 were increased after Tx, resulting in unchanged oxygen delivery (CaO2 x CBF) post-Tx. Moreover, OEF and CMRO2 were not significantly different pre- and post-Tx, consistent with our hypothesis that CBF increases to maintain oxygen delivery. Conclusions: Elevated CBF is likely a compensatory mechanism to maintain constant oxygen delivery in SCD children who have chronically low CaO2. In our subjects, Tx improved CaO2, allowing CBF to normalize. This reduced hemodynamic stress likely contributes to the lower stroke risk in chronically transfused SCD children.

Abstract 171: Cerebral Blood Flow and Oxygen Extraction Fraction are Age-dependent in Children and Young Adults with and without Sickle Cell Disease

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kristin P Guilliams ◽  
Melanie E Fields ◽  
Michael M Binkley ◽  
Dustin K Ragan ◽  
Cihat Eldeniz ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Young Children ◽  
Multiple Regression ◽  
Sickle Cell ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Cell Disease ◽  
Stroke Incidence ◽  
Cerebral Oxygen Metabolism ◽  
Age Dependent

Introduction: Children with sickle cell disease (SCD) are a high risk population for pediatric stroke. Young children with SCD have a higher stroke incidence than older children. Cerebral oxygen metabolism, the product of CBF, OEF and arterial oxygen content (CaO 2 , [oxygen saturation (SpO 2 ) x hemoglobin (Hb) x 1.36]) is age-dependent in healthy children, peaking at 5-9 years of age. CBF is age-dependent, but OEF variation across childhood is not well-studied. In non-SCD adults, elevated OEF confers higher stroke risk. Children with SCD have higher CBF and OEF than healthy controls, but also have lower CaO 2 . It is unknown if age independently influences CBF and OEF. We hypothesized that age, sex and CaO 2 influence components of cerebral oxygen metabolism, as measured by MRI. Methods: Subjects with SCD and sibling/relative controls without SCD underwent brain MRI with measurement of CBF and OEF by pseudocontinuous arterial spin labeling and asymmetric spin echo sequences, respectively. Blood samples were obtained for Hb and hematocrit values. A fast inversion recovery sequence measured T1 values in the superior sagittal sinus. A multiple regression model determined significant factors influencing CBF and OEF (age, sex, CaO 2 ). Results: We scanned 25 subjects without SCD (ages 6-27) and 56 subjects with SCD (ages 5-28). In multiple regression analysis, age (p=0.0009) and CaO 2 (p < 0.0001) were significantly predictive of CBF, controlling for sex. Age (p=0.027) and CaO 2 (p<0.0001), were also significantly predictive of OEF, controlling for sex. Conclusion: Age is an independent predictor of CBF and OEF. Younger children have higher CBF and OEF, even after controlling for the lower CaO 2 associated with SCD. This may explain the increased stroke incidence in young children with SCD.

scholarly journals Effect of supplemental dexmedetomidine in interventional embolism on cerebral oxygen metabolism in patients with intracranial aneurysms

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110029
Author(s):  
Zhang Guo ◽  
Weiwei Wang ◽  
Dahua Xie ◽  
Ruisheng Lin
Keyword(s):  
Intracranial Aneurysms ◽  
Jugular Vein ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Cerebral Oxygen Metabolism ◽  
Time Points ◽  
Venous Oxygen Saturation ◽  
Group A ◽  
Group B ◽  
Oxygen Difference

Objective To investigate the effect of supplemental dexmedetomidine in interventional embolism on cerebral oxygen metabolism in patients with intracranial aneurysms. Methods Ninety patients who underwent interventional embolism of intracranial aneurysms were equally divided into Group A and Group B. In Group A, dexmedetomidine was injected intravenously 10 minutes before inducing anesthesia, with a loading dose of 0.6 µg/kg followed by 0.4 µg/kg/hour. Group B received the same amount of normal saline by the same injection method. Heart rate (HR), mean arterial pressure (MAP), arterial–jugular venous oxygen difference [D(a-jv) (O2)], cerebral oxygen extraction [CE (O2)], and intraoperative propofol use were recorded before inducing anesthesia (T0) and at five time points thereafter. Results The amount of propofol in Group A was lower vs Group B. At all five time points after T0, HR, MAP, D(a-jv) (O2), and CE (O2) in Group A were significantly lower vs Group B, with significant differences for jugular venous oxygen saturation (SjvO2) and the oxygen content of the internal jugular vein (CjvO2) between the groups. Conclusion Dexmedetomidine resulted in less intraoperative propofol, lower D(a-jv) (O2) and CE (O2), and improved cerebral oxygen metabolism.

scholarly journals Effect of Chlorpromazine on Cerebral Hemodynamics and Cerebral Oxygen Metabolism in Man

Circulation ◽  
1956 ◽  
Vol 14 (3) ◽  
pp. 380-385 ◽  
Author(s):  
JOHN H. MOYER ◽  
GEORGE MORRIS ◽  
ROBERT PONTIUS ◽  
ROBERT HERSHBERGER ◽  
C. Polk Smith
Keyword(s):  
Oxygen Metabolism ◽  
Cerebral Hemodynamics ◽  
Cerebral Oxygen ◽  
Cerebral Oxygen Metabolism
Sign in / Sign up

Export Citation Format

Share Document