Grading of Dynamic Cerebral Autoregulation Without Blood Pressure Recordings: A Simple Doppler-Based Method

Abstract

Transcranial Doppler sonography allows for noninvasive assessment of dynamic cerebral autoregulation. A wider clinical use of this approach has been hampered by the need for continuous arterial blood pressure (ABP) measurements. We describe a new method of a pure Doppler signal based estimation of dynamic autoregulation using heart rate (HR) and cerebral blood flow velocity (CBFV) information. The phase between these two signals was assessed from 0.1 Hz oscillations induced by regular breathing. We compared this new approach with the standard method (phase between ABP and CBFV oscillations) in 93 patients with unilateral severe carotid artery obstruction. On a group level, the phase HR-CBFV differed significantly between ipsi- and contralateral sides (p = 0.024) and correlated significantly with the standard phase ABP-CBFV (r = 0.369, p < 0.001). The proposed method can, thus, detect impaired dynamic autoregulation in occlusive carotid artery disease using a single Doppler probe.