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2014 ; 45
(6
): 1771-7
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Relative contributions of sympathetic, cholinergic, and myogenic mechanisms to
cerebral autoregulation
#MMPMID24723314
Hamner JW
; Tan CO
Stroke
2014[Jun]; 45
(6
): 1771-7
PMID24723314
show ga
BACKGROUND AND PURPOSE: Prior work aimed at improving our understanding of human
cerebral autoregulation has explored individual physiological mechanisms of
autoregulation in isolation, but none has attempted to consolidate the individual
roles of these mechanisms into a comprehensive model of the overall cerebral
pressure-flow relationship. METHODS: We retrospectively analyzed this
relationship before and after pharmacological blockade of ?-adrenergic-,
muscarinic-, and calcium channel-mediated mechanisms in 43 healthy volunteers to
determine the relative contributions of the sympathetic, cholinergic, and
myogenic controllers to cerebral autoregulation. Projection pursuit regression
was used to assess the effect of pharmacological blockade on the cerebral
pressure-flow relationship. Subsequently, ANCOVA decomposition was used to
determine the cumulative effect of these 3 mechanisms on cerebral autoregulation
and whether they can fully explain it. RESULTS: Sympathetic, cholinergic, and
myogenic mechanisms together accounted for 62% of the cerebral pressure-flow
relationship (P<0.05), with significant and distinct contributions from each of
the 3 effectors. ANCOVA decomposition demonstrated that myogenic effectors were
the largest determinant of the cerebral pressure-flow relationship, but their
effect was outside of the autoregulatory region where neurogenic control appeared
prepotent. CONCLUSIONS: Our results suggest that myogenic effects occur outside
the active region of autoregulation, whereas neurogenic influences are largely
responsible for cerebral blood flow control within it. However, our model of
cerebral autoregulation left 38% of the cerebral pressure-flow relationship
unexplained, suggesting that there are other physiological mechanisms that
contribute to cerebral autoregulation.
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