• J R Caldas, R B Panerai, V J Haunton, J P Almeida, G S R Ferreira, L Camara, R C Nogueira, E Bor-Seng-Shu, M L Oliveira, R R V Groehs, L Ferreira-Santos, M J Teixeira, F R B G Galas, T G Robinson, F B Jatene, and L A Hajjar.
• Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil.
• Am. J. Physiol. Regul. Integr. Comp. Physiol. 2017 Jan 1; 312 (1): R108-R113.

AbstractPatients with ischemic heart failure (iHF) have a high risk of neurological complications such as cognitive impairment and stroke. We hypothesized that iHF patients have a higher incidence of impaired dynamic cerebral autoregulation (dCA). Adult patients with iHF and healthy volunteers were included. Cerebral blood flow velocity (CBFV, transcranial Doppler, middle cerebral artery), end-tidal CO2 (capnography), and arterial blood pressure (Finometer) were continuously recorded supine for 5 min at rest. Autoregulation index (ARI) was estimated from the CBFV step response derived by transfer function analysis using standard template curves. Fifty-two iHF patients and 54 age-, gender-, and BP-matched healthy volunteers were studied. Echocardiogram ejection fraction was 40 (20-45) % in iHF group. iHF patients compared with control subjects had reduced end-tidal CO2 (34.1 ± 3.7 vs. 38.3 ± 4.0 mmHg, P < 0.001) and lower ARI values (5.1 ± 1.6 vs. 5.9 ± 1.0, P = 0.012). ARI <4, suggestive of impaired CA, was more common in iHF patients (28.8 vs. 7.4%, P = 0.004). These results confirm that iHF patients are more likely to have impaired dCA compared with age-matched controls. The relationship between impaired dCA and neurological complications in iHF patients deserves further investigation.Copyright © 2017 the American Physiological Society.

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